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APPLICATION
Nurses, register now for FREE
membership.
This Application Form has 2 Sections:
SECTION (A) contains the essential details
needed to ensure we can always contact you. This is all that
is required for you to enjoy all the benefits of membership
free access to the SHOPPING MALL of merchants on the website
plus free weekly email NEWSLETTERS.
SECTION (B) for those who would like
to request a hard copy version of the SHOPPING MALL (charges
apply)
We remind you of our Privacy policy which
states that NONE of your details will be released to any third
party.
MEMBERSHIP APPLICATION FORM
SECTION (A)
I understand that :
- MEMBERSHIP IS FREE. I will not be asked
to pay any money today or later for membership
- MEMBERSHIP is for 12 months from today's
date
- MEMBERSHIP entitles me to :
- Receive the weekly email NEWSLETTER
- Access the SHOPPING MALL of
preferred merchants ON THE WEB
I have
read and accept the above
Home address
POSTCODE
Phone:
Mobile:
Name of current workplace:
Email address:
SECTION (B)
Yes, I wish to have a printed version
of the Shopping Mall (the DIRECTORY) posted to me 4 times a year.
I agree to pay $19-95 to defray costs.
Card details :
Card Number
Expiry date
Name on card :
(Please click button
once only please.)
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