MEMBERSHIP FORM
(Print this page and mail it to the address shown below)

o Yes! I would like to become a member of the Australian
    Drug Law Reform Foundation Inc.
    Enclosed is $50 for membership. (Concession for unwaged $30)
    I endorse and support the principles expressed in the Charter (read charter here >>)

o Yes! I would like to make a donation to the Australian
    Drug Law Reform Foundation Inc.
    Please find enclosed __ $500 __ $250 __ $100 __ Other $______

o Please send me more information about the Australian Drug Law Reform Foundation Inc.

I am paying by: __ Cheque   __ Money Order   __ VISA   __ Mastercard   

Card No: __|__|__|__|  __|__|__|__|  __|__|__|__|  __|__|__|__|   Exp. Date:___/___
                                                                                                                                (mm/yy)

Name on card: _________________________________________________

Signature: _________________________________________________________

o Please keep my name confidential

Name:____________________________________________________________

Address: __________________________________________________________

_________________________________________________________________

Phone: ______________ (h)   ______________ (w) _______________ (fax)

E-Mail: ___________________________________________________________

Please make cheques payable to the Australian Drug Law Reform Foundation. Send membership fees and/or donation to the address below: 

Secretary
ADLRF
PO Box R169
Royal Exchange Post Shop
NSW  1225