Registration of Organisational Interest in
Boroondara Stroke Support Group

If you represent an organisation and wish to register your interest in the Boroondara Stroke Support Group please enter the following information and click the 'Submit details' button.

Enter Organisational Registration Details
Organisation details Organisation name:
Street address:
Postal address:
Locality in Boroondara:
Locality outside Boroondara:   Postcode:
State:
Business phone:
Email address:
Website URL:
Details of Contact Person Title:   Given name:   Family name:
Position title:
Contact phone:
Contact email:
Nature of Organisation
(Choose one)
 
Service requested from BSSG
(Choose one or more)
Become BSSG Associate Receive BSSG Newsletter
Receive BSSG Services Guide Include in BSSG Services Guide
Receive BSSG Stroke Recovery DVD  
Service offered to BSSG
(Choose one or more)
Make donation to BSSG Sponsor BSSG Education Grant
Sponsor BSSG Activity Program  
Submit request :