the child accident prevention foundation of australia

Kidsafe Services - Member's Entry

Please complete with your details below and return this form and your subscription to Kidsafe WA.


     Home
     Business
     Mobile


Membership Categories and Subscriptions

(Please tick your selection below)

Individual/Family $50.00
Student* $25.00
Community Organisation $100.00
Corporate Membership $250.00

* must be fulltime student & provide evidence of current enrolment status


Payment Method

Enclosed is my membership subscription of $ ____________________. I am paying by
(Please tick one below)

Cash Cheque Money Order Credit Card






Please complete the details below

Office Use Only


Thank you for your interest in child injury prevention. As a member of Kidsafe Western Australia (Inc) you will be helping to support the leading non-government, not-for-profit organisation dedicated to childhood injury prevention in Western Australia. Kidsafe WA is the WA member and affiliate of the Child Accident Prevention Foundation of Australia (Kidsafe Australia). Kidsafe WA membership renewals become due in July of each year, with renewal payments due by 30th September to maintain current membership status. Interested members are eligible to nominate for positions on the State Board. Other members may choose to offer their assistance or expertise in other areas.


Areas of Interest

As a member of Kidsafe Western Australia (Inc), I would like to offer my assistance and expertise

in the following areas to support the work of Kidsafe Western Australia (Inc).

Please tick those interested in


Fundraising
Marketing & Promotions
Research
Policy Development
Advocacy
Technical knowledge / expertise (Please specify – the list below is a starting point)
  Road / Transport Safety School Safety

Drowning Eye Injuries

Falls Sport & Recreational Safety

Playgrounds Product Safety

Poisoning Home Safety

Burns & Scalds
Fire Safety

Other (Please specify)


Please return this form to:

Kidsafe WA
GPO Box D184
PERTH WA 6840

Or Fax to:
9340 8041

With your payment

Thank you