Club FAMILY Membership

The Club family membership is for more than one person from a household that attends a local Stroke Recovery Club/group/choir.

This membership type covers more than one person from your household that attends the local Club/group/choir.

Please enter all people under this membership on the form below.

If only one person from your household attends the local Club/group/choir, you will need to get a Club single membership here.

Price:

$25 for access until August 31, 2023

First Name:* First Name Required

Last Name:* Last Name Required

Address Line 1:* Address Line 1 is Required

Address Line 2: Address Line 2 is not valid

City:* City is Required

Country:* Country is Required

State/Province:* State/Province is Required

Zip/Postal Code:* Zip/Postal Code is Required

Date of birth: Date of birth is not valid

Additional names of people on family membership: Additional names of people on family membership is not valid

Stroke Recovery Club/group/choir:* Stroke Recovery Club/group/choir is Required

Primary phone number:* Primary phone number is Required

Select all that apply to people in this membership. I am a:* Select all that apply to people in this membership. I am a is Required

Stroke Survivor Carer Health Professional Volunteer

I would like to receive newsletters by:* I would like to receive newsletters by is Required

Email Mail Both mail and email

Would you like to be on the weekly online group mailing list?: Would you like to be on the weekly online group mailing list? is not valid

Yes No

Would you like to receive information about Aphasia NSW?: Would you like to receive information about Aphasia NSW? is not valid

Yes No

Is your background culturally or linguistically diverse?: Is your background culturally or linguistically diverse? is not valid

Yes No

Are you of Aboriginal or Torres Strait Islander descent?: Are you of Aboriginal or Torres Strait Islander descent? is not valid

Yes No

I acknowledge that I have read and understand the Stroke Recovery Association’s COVID-19 vaccination policy (https://strokensw.org.au/wp-content/uploads/2022/08/COVID-19-policy.pdf). *

I agree to abide by the policies and procedures of the Stroke Recovery Association and understand that my details are kept on a confidential database of members as required by the Associations Incorporation Act 2009 and the Associations Incorporation Regulation 2010. *

I give permission for any photos taken of me during Stroke Club/group/choir activities to be used for promotion by the Stroke Recovery Association in publications and/or on social media.*

Email:* Invalid Email

Password:* Invalid Password

Password Confirmation:* Password Confirmation Doesn't Match

Password Strength Password must be "Medium" or stronger

Description	Amount
Club FAMILY Membership – Initial Payment	$25.00
Total	$25.00

Pay via credit or debit card

Name on the card:* Name on the card is required.

Credit Card:*

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