LUPUS ASSOCIATION of TASMANIA  inc.

                                                                               PO  Box 639, Launceston 7250

                                                              Email: hdenise@bigpond.net.au

                                                                   Website: www.lupustas.org

The Lupus Association of Tasmania inc. is committed to understanding and supporting those persons with lupus and any auto-immune disease which cluster with lupus, in three ways:

1. By educating and informing patients and their families, and the general public.

2. By providing support in the form of encouragement and service to lupus sufferers.

3. By promoting and supporting research designed to discover the cause of and a cure for lupus.         

 

NEW MEMBERSHIP

SUBSCRIPTION:  2008                  $15       Family

1st January-31st December        $10      Single

                                                $  5      Badge

                                                                $.…….Donation                               Total Enclosed $……….

 

Please complete form, print and forward with cheque payable to:          Lupus Association of Tasmania inc.

                                                                                                P.O.Box 639,  LAUNCESTON, 7250, Tas.

 

 

TITLE…..…...SURNAME:…………………………………………...Given Names…………….……………….

 

ADDRESS:………………………………………………………………………………………

 

P/Code…………....Phone……..………………………..Your email:…………………….………...…………….

 

Date of Birth……………………………….                            Year Diagnosed…………………………………

 

I suffer from (please circle):  Systemic Lupus Erythematosus(SLE):   Discoid lupus:   Mixed Connective Tissue Disease(MCTD): Fibromyalgia: Polymyositis:  Polymyasthenia:  Rheumatoid Arthritis:   Sjogren’s Syndrome(SS) Primary or Secondary:      Diabetes:     Anemia:  Antiphospholipid Syndrome(APS):     I.T.P.:     Raynaud’s Phenomenon:       Scleroderma:    Polymyalgia:     Spondylosis:     Other:---

 

Area of lupus involvement:  Kidneys. Central Nervous System.  Thyroid….   Joints.   Muscles.   Tissue.      Tendons.    Skin.    Brain.    Lungs.     Heart.   Eyes.    Blood.    Bowel.   Other:---

Any Familial Tendency: (Blood relations)?………………………………………….…………

 

G.P……………………………………SPECIALIST…….…………………….….    Could you attend working bees?………

 

 

MEMBERSHIP IS OUR MAIN CONTINUING SOURCE OF INCOME

Association members receive a quarterly newsletter and have available to them, on request, information on specific aspects of lupus and related autoimmune diseases, together with excellent up-to-date books and some videos for hire.  Research into your specific disease will be done on request.                                                                               JOIN NOW AND RECEIVE A FREE BOOKLET

 

YOUR SUPPORT IS VITAL TO LUPUS & AUTOIMMUNE DISEASE AWARENESS

Registered Charity – ABN 96 163 951 956

 

Donations over $2 are tax deductible

 

“The Lupus Association of Tasmania inc. recognizes your privacy is important and is committed to the protection of your personal information.  In accordance with the Commonwealth Privacy Amendment Act 2000 we will not disclose personal information to third parties without your consent.  Your personal information is collected to enable us to maintain an up-to-date membership database and target our services in the best interests of members.  You have the right to gain access to your personal information held by the Association and have it corrected if necessary.”