Membership Form

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Membership Form

Membership Details

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First Name *

Last Name *

Address 1 *

Address 2 *

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Email *

Date of Birth (DD/MM/YYYY) *

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Main Phone *

Home Phone

Work Phone

I understand that the information I provide will used for membership purposes only and will not be shared with a third party without my consent. *

Shine relies on donations to continue its work and provide much needed services to people with mental ill health as well as their family members and carers.

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