DSANT Membership Form

Child’s date of birth:

Home Address:

Postal Address (If Different to Home Address):

Phone:

Other:

I give permission for DSANT to use my child’s photograph in group and individual situations in printed publications or on project noticeboards.

I give permission for DSANT to use my child’s photograph in group and individual situations on the Down Syndrome Association NT (DSANT) website and DSANT Facebook pages.

I give permission for DSANT to use my child’s image in video or webcam footage of group and individual situations on the Down Syndrome Association NT (DSANT) website and DSANT Facebook pages

DSANT Membership costs:
DSANT Family/ Associate membership : $55
Computer Aided Learning (CAL) $130 (including DSANT membership of $55 and CAL membership $75) is necessary in order for your child to receive the CAL program in schools.

Bank Details (for direct deposit):
Down Syndrome Association NT Inc
BSB: 633000
Account: 144690443
(Please include your Surname as reference)

Payment via Direct Deposit:
I have transferred money via Direct Deposit to the Down Syndrome Association NT account to pay the

$55 for DSANT family membership$130 for CAL membership ($75) plus DSANT family membership ($55)I am currently experiencing financial hardship and would like to discuss other payment options