Become a Member

 

If you’re over 50 you can become a member of the Ipswich 60 and Better Program for only $15.00 for a whole year.

 

There are 2 easy ways to become a member:

 
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Option [1] Call us and apply for Membership ‘Over the Phone’

Simply contact our Coordinator Anne Bertram on Ph: 07 3282 8644 who will assist you with your Membership Application.

 
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or Option [2] Complete our ‘Online’ Membership Application Form

Simply complete the Membership Application form below. Once we receive your form we’ll contact you to confirm your membership.

 

Membership-Page-IconMembership Application Form – Ipswich 60 and Better Program

 
 

Your Name
Mr Mrs Ms Miss 

Your Address

Your Phone

Your Email

Your Date of Birth

Newsletter Requirement

Please tick the appropriate option below to indicate in which format
you prefer your copy of the Newsletter.
Standard A5 Size Enlarged A4 Size Audio Tape Email Audio File (3mb) 

Next of kin contact details in case of an emergency:

Name

Phone - Home

Phone - Work

Any health issues you want us to know about?

How did you hear about us?

 

I hereby apply for membership of the Ipswich 60 and Better Program Inc. I agree to abide by the rules of the Incorporation, Code of Ethics and Procedures and the By-laws of the Association. I undertake a program’s activity at my own risk and acknowledge and voluntarily accept the level of risk relative to that activity.

I understand that information collected on this form is for the sole purpose of data collection for the Ipswich 60 and Better Program Inc. and that none of this information will be disclosed to a third party without my knowledge.
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