Newsletter First name Last name Membership Type Full member (a person with polio) Associate Member (a person without polio) Supporter (I don’t wish to join but please send me the newsletter) Contact Details Email Phone Number Postal Address Phone Suburb / Town Postcode StateVictoriaACTNew South WalesNorthern TerritoryQueenslandSouth AutraliaTasmaniaWestern Australia I have read the objectives of Post Polio Victoria Inc and I wish to become a member
