B.       Member Details

Please complete:

Name of Individual
Prof   Dr   Mrs   Mr   Ms
First Name   Surname

Organisation name (if applicable)

Postal Address

 

Town: State    Postcode

Tel (BH):    Email: 

Fax:           Mobile:

Please indicate if you would prefer future correspondence from ADCA in electronic format.

D.     Membership Information

To enable us to better advocate on behalf of the AOD sector and to improve the
delivery of services to members, it would be appreciated if you could provide the
following information for inclusion in the ADCA database:

1. What would you describe as your core business or that of your organisation? (please select from the following)

2. Do you or your organisation specifically target any particular population group? (please select from the following)

E.      Declaration

In making this application, I declare my support for the mission of ADCA:

ADCA, as a national peak body for the alcohol and other drugs sector, is committed to the principle of harm minimisation.  ADCA works collaboratively with the government, non-government, business and community sectors to promote evidence-based, socially just, approaches aimed at preventing or reducing the health, economic and social harm caused by alcohol and other drugs to individuals, families, communities and the nation.

Agreement to conditions of use:

My ADCA membership entitles me to individual use only of the NDSIS electronic services.

The use of NDSIS Electronic Services including viewing, printing and downloading of individual articles is for the purpose of study, teaching and research. That the downloading of an entire journal issue in a systematic fashion is strictly prohibited and that information must not be used for commercial purposes or re-sold in any way.

Any NDSIS material borrowed by me that is lost or returned damaged will incur a fine to pay for the repair or replacement cost.            

Signature:........................................................  Date: ....../....../......

              (must be signed by nominated individual)

Name:        

Phone:           Email:

F.     Payment Details

A Cheque/Money Order made payable to 'ADCA' is enclosed
           OR
Please charge the credit card indicated

Visa      Mastercard     Bankcard

Card Number: Exp Date:

Signature:           Date:

Please check all details are complete, print form, sign it and then fax (02) 6281 0995.

Thankyou.

Privacy Policy

ADCA collects personal information to allow us to obtain an accurate profile of
our members, so as we can better meet their information needs and advocate
on behalf of the sector. The names of organisations and individuals who are members of
ADCA are published in the ADCA Annual Report and may be cited on other
occasions as an example of the types of organisations/individuals ADCA represents.
ADCA's Privacy Policy fully outlines the purposes for which information is collected
and to whom it may be disclosed.