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| Application To Join CleftPALS Qld Inc I wish to subscribe/renew our membership of CleftPALS Qld Inc for the period 2006/2007
Our Child is a Boy/Girl. …………………………………………………… (name) and was born at: ……………………………………………………………………on: ……/……/……… Hospital where surgery will take place is:………………………………………………………… Type of Cleft:
We enclose:
Method of Payment:
Note: Other than for donations, receipts will not be issued unless requested. Receipt required To assist with fundraising, I agree/decline to receive raffle tickets to sell as a ticket seller on behalf of CleftPals Qld Inc. (guidelines to the conduct of Minor Art Unions in Queensland) Agree Decline Signature: .................................................Date: ................... (Donations to CleftPals of $2 or over are deductible for Income Tax purposes)
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