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Application for membership of the NSW Rural Doctors Network Ltd

Incorporated under the Corporations Law sub-section 121(1)
ACN 081 388 810 ABN 52 081 388 810

Please complete the following form, or download the hard copy and send or fax it back to:

RDN Board Scretariat
PO Box 1111
MASCOT NSW 1460

Phone: 02 83378100
Fax: 02 83378110
Email: membership@nswrdn.com.au

Applicant Details
Title:
First name:
Other names:
Surname:
Occupation:
Address:
Line 1 
Line 2 
Suburb 
State  Postcode 
Country 
Phone:
Fax:
Email:
 
I hereby apply to become a of the above mentioned incorporated Company. In the event of my admission as a Primary or Associate Member, I agree to be bound by the rules of the Company.
I would like to receive additional information about RDN activities including the Electronic Monday Message
 

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