Individual Membership

Should you require assistance completing this form please contact our office on : Brisbane area 300 300 65 and outside Brisbane (free call) 1800 000 999

Membership is available either as an INDIVIDUAL at the cost of $20.00 per annum or as a FAMILY at a cost of $25.00 per annum. Family membership only applies to members of the one family who reside at the same address and who are over the age of eighteen. Membership is due for renewal on July 1 of each year.

Name
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Address
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Contact details
  3. (valid email required)
Member Profile
Eye Conditions
  2. Which eye disease has been diagnosed?
Services
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  2. Please select the services you would like to receive
 

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