Membership Application
First Name (*)
Invalid Input
Last Name (*)
Invalid Input
Date of Birth
Day (*)
Invalid Input
Month (*)
Invalid Input
Year
Invalid Input
Address (*)
Invalid Input
Address Line 2
Invalid Input
Suburb (*)
Invalid Input
Postal Code (*)
Invalid Input
Phone Number (*)
Invalid Input
Mobile Phone
Invalid Input
Fax Number
Invalid Input
Email
Invalid Input
What is your interest in MS Queensland? (*)



Invalid Input
(*)



Invalid Input
Services are delivered to registered clients on the basis of individual assessment and identified needs. If you want more information on any matter (application, publications, available services) call toll free 1800 177 591.
  

1800 287 367 or MS INFO 1800 177 591   
         

Increase Size
 Increase font sizeDefault font sizeDecrease font size
 

Membership Application Form

Membership Form (PDF)

If you don't want to apply online, download the above form, print, complete your details and mail with your payment to:

MS Queensland

Locked Bag 370
COORPAROO DC QLD 4151
Fax: (07) 3840 0813
Email: mssociety@msqld.org.au