Become-a-member

    Contact Details

    Your Full Name *

    Your Full Postal Address *

    Your Email*

    Contact Phone Number*

    Are you a new member or renewing your membership?
    New membershipRenewalUpdate of details (no payment required)

    What's your interest in joining AusDoCC?
    Individual with a Disorder of the Corpus CallosumParent of a child/adult with a DCCOther relative of a child/adult with DCCProfessional working with people affected by a DCCPerson or organisation interested in DCCs

    Membership Option

    Family Details

    Child 1 or adult with a DCC

    Full Name

    Date of birth

    Gender

    DCC diagnosis

    If DCC is associated with another condition, please provide details

    Child 2 or adult with a DCC

    Full Name

    Date of birth

    Gender

    Condition

    If DCC is associated with another condition, please provide details

    I desire to become a member of AusDoCC Inc. I agree to support the purposes and rules of AusDoCC and accept the terms and conditions of
    application for membership as detailed on the Association website www.ausdocc.org.au. I declare that all the information given on this form is
    true and correct.

    Please Consider making a donation along with your application. All donations over $2.00 are tax deductible.

    Contact and Privacy

    The information collected in this form is for the use of AusDoCC Inc. and affiliated branches only. Information is confidential and will not be
    shared with any third party without prior consent. The Privacy Act 1988 allows applicants to access and amend their personal information at
    any time.

    AusDocc Inc. uses email to share newsletters, updates about upcoming events and other resources for AusDoCC members.

    I wish to receive email from AusDoCC Inc.
    I consent to be on a contact list for families of DCC.



    Payment options are Paypal (accepts credit card), and BSB Bank Transfer.