Membership Application Form 2007

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New Zealand or Australian residents only please If you are from outside this area, you are welcome to subscribe to the Network News Before you use this form, please make sure that the url in the address line of your browser is http://www.ftmaustralia.org/members/appform.html - otherwise this form might not work properly. To be 100% sure, click on that url. I understand the following information will be kept on a secure and private database —Yes - I understand Please send me Torque newsletter via the post (Australia and New Zealand only) —Yes please First Name —required Surname —required Birthdate —required Contact Details Phone (H) Phone (M) Phone (W) Email —required If you have no email - type NO EMAIL Please subscribe me to receive the Network News YesoNo Your Postal Details PO Box/ or Residential —required City —required State/Territory === please select === New South Wales Queensland South Australia Australian Capital Territory Northern Territory Western Australia Tasmania Victoria not applicable —required Postcode —required Country —required Australia-or New Zealand About you Are you of Non English Speaking Background (NESB)?—required Yes --- No Are you of Aboriginal, Mãori or Torres Strait/Pacific Islander descent?—required Yes --- No I am... —required a man with ts a partner and/or family member a service provider a transgender person other - I heard about FTM Australia through... —required Please tell us a little bit about yourself and your interest in the mtra/ftma network or what you would like from us. YOU HAVE COMPLETED THIS MEMBERSHIP FORM

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