Membership

Renew Your Membership

If you you would like to renew your Diabetes WA membership you can do so by using our online renewal form below. The form is an easy 4 step process and you will need your credit card details to complete the process.

Step 1 of 4: Membership Details

To begin the Membership Renewal process please enter your membership number and personal details below. When you are happy with the information click the 'Next' button.

Fields marked with (*) are required fields.

Personal Details

Title:*

Surname:*

Given names:*

Date of birth:*

YYYY

Postal Details

Address:*
Suburb:*
Postcode:*

Contact Details

Daytime telephone:*
Mobile:
Email:*

Membership Details

Membership No:*
Membership Type:* (Concession membership is available to Seniors, Pensioners, DVA, Healthcare or Student cardholders, or a person under 18 years of age)		Full Member (1 Year) $50.00
		Full Member (2 Years) $90.00
		Concession Member (1 Year) $26.00
		Concession Member (2 Years) $46.00

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