Name

Email Address

Phone

Are you a Cystic Fibrosis Queensland, ACT and NT member? Are you a Cystic Fibrosis Queensland, ACT and NT member? Yes No, I want to join Cystic Fibrosis Queensland, ACT and NT and will complete a membership application form No, but I am a member of another charity within the Cystic Fibrosis Federation of Australia. No, I do not belong to a Cystic Fibrosis Federation of Australia charity, and agree to the fees of $70 plus gst per hour for each booking, minimum booking is a two-hour session.

Which charity do you belong to? Please email proof of membership to services@cfqld.org.au Which charity do you belong to? Please email proof of membership to services@cfqld.org.au Cystic Fibrosis South Australia Cystic Fibrosis Tasmania Cystic Fibrosis Western Australia

Please provide billing information including name, address, phone and email.