Dying With Dignity ACT

Welcome to DWDACT

    1. About You

    Title

    Your First Name

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    For Couples Membership

    Your Email

    Street/PO Box

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    2. Type of membership

    Type of Membership


    *concession rates apply to means-tested pensioners

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    3. Payment Method

    Select your payment method

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    Bank Details:
    The email acknowledging your lodgment of this form will contain details of our bank account

    Cheques to:
    PO Box 55
    Waramanga ACT 2611

    4. Lodge your completed form

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