Spinal ACT Membership Registration
Become a member of Spinal ACT.
Email address *
First Name *
Your answer
Last Name
Your answer
Are you a resident of the Australian Capital Territory? *
Do you have a Spinal Cord Injury? *
What is the level of your Spinal Cord Injury? (if applicable)
Your answer
In what year did you suffer your Spinal Cord Injury? (if applicable)
Your answer
Do you assume a care giving or therapeutic service provision role for any individuals living with Spinal Cord Injury?
Are you or anyone known to you interested in becoming a member of the Spinal ACT committee?
Would you like to receive information from Spinal ACT via email notification? *
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