Membership Application

Membership of the Dialysis & Transplant Association of Victoria Inc. is open to any person who is involved with renal conditions, including family, carers and friends. Membership costs only $15 per person, and is due on the first of July each year.

To apply and renew by mail

If you would prefer to apply for a new membership and send it by mail, please print out and complete the New Members Form

Or to renew you membership, just print out and complete Renewal Form

When you complete either form, please send it with your remittance to:

The Treasurer
D.A.T.A. Inc.
P.O. Box 159
Forest Hill VIC 3131

Membership for Associates

To apply for a Membership as an individual, please complete the form below:

  • Your Details

  • Required phone number format: ## #### ####
  • Required phone number format: ## #### ####
  • Required phone number format: #### ### ###
  • Your Work

  • Account Password

  • Type your password. Minimum length of 8 characters.
    The password must have a minimum strength of Very Weak.
    Strength indicator
  • Type your password again.
    • Payment Details & Billing Address

  • Renal Condition

  • (If applicable)
  • Please provide details
  • (If different to Hospital)