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First Name  
Last Name  
Date of Birth  (dd/mm/yyyy)
Postal Address  
Diabetes Type  
Membership Type (*See below for details of NIPRO offer)
Membership Number
Membership Amount $37
Donation Amount ($)  (*donations of $2 or more are tax deductible)   
Total Amount $37

*We have a fantastic new offer that we encourage you to take advantage of. When you renew your membership you can get an additional year for just $10, PLUS you will receive a free Nipro Monitor. Please opt in when you renew above, or if you would like more information call 6215 9000.

Delivery details – Membership is for a 12 month period. Your renewed membership card will be posted to your mailing address by ordinary post within seven working days.

© 2016 Diabetes Tasmania. Diabetes Australia - Tasmania trading as Diabetes Tasmania ABN 90 087 092 180.
Level 7, 152 Macquarie Street, Hobart TAS 7000. Phone 03 6215 9000, Fax: 03 6215 9099.

For all information regarding our refunds policy please contact us on 6215 9000 Monday to Friday 9.00am to 5.00pm, closed Public Holidays.

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