Unfortunately we do not have facility for
electronic lodgement of forms at this time.
If you wish, email the national
office drs@drs.org.au with your
details and request an invoice be sent to you.
Alternatively,
PRINT THIS
PAGE,
complete the questions below, and then
FAX to 02-9613 8305,
or mail to
Doctors Reform Society of Australia
PO 59
Rydalmere BC, NSW 1707.
Name: ___________________________________________________________
Preferred Postal Address: ___________________________________________
_________________________________________________________________
Tick payment method: Send Invoice ___ Cheque attached ____ Credit card ___
For Credit card only: circle:Mastercard Visa Amex Expiry date: ____/_____
Name on Card _____________________________________________________
Credit card number: ________ ________ ________ ________
Signature:
Date:
___________/______________/______________
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