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Membership and Information Form

Would you like to contact Diabetes Christchurch for more information about our products, diabetes information pamphlets and/or a membership application form. Please fill in the request form below, print a copy and fax to (03) 378-6196 or use the submit request button at the bottom of the member and information request form and it will be automatically emailed to us.

  MEMBERSHIP AND INFORMATION REQUEST FORM  

   1. Please tick the box below, insert any queries or comment/s you may have, and then let us know how to contact you and we will post you a membership payment form.

     A. Yes, I would like to join Diabetes Christchurch. 

      Comments:

   Contact Information:

 NAME

 ADDRESS

 

 PHONE (Home)
 PHONE (Work)
 MOBILE
 FAX
 EMAIL

DIABETES CHRISTCHURCH INCORPORATED

ADDRESSES:

 TELEPHONE/FAX:

 ADDRESSES:

Ground Floor, 550 Hagley Avenue, Christchurch.

PO Box 2527,  Christchurch, 

South Island,  New Zealand.

Phone  64 3 378-6266 

Fax  64 3 378-6196

 info@barnabybee.com

sales@barnabybee.com

lynne.taylor@cdhb.govt.nz