Please complete all the fields in this form click on the print button on your browser and post it to the address below.

Please accept my Disability Information Directories And Access and Equity Report Order Form

Name of Applicant
Name of Agency
Address
Suburb
State
Post Code
Phone
Fax
E-mail
Please tick the box for the resources you require.
Access and Equity Project Report (Cost $20)) ____
Directory of Disability Information Services in the following languages (free).
___	English
___	Arabic
___	Chinese
___	Croatian
___	Greek
___	Italian
___	Macedonian
___	Maltese
___	Polish
___	Spanish
___	Turkish
___	Vietnamese
NOTE: Postage & Handling
Victoria - 1 Booklet $3-00 - 2 or more Booklets $5-00
Interstate - 1 Booklet $5-00 - 2 or more Booklets $10-00

Please mail the printed form to:
ADEC,
13 Munro Street,
Coburg, Vic, 3058,
Australia
or fax it through on
(03) 9383 5185.



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