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Registration

Glaucoma NZ Public Membership

Yes, I wish to enrol with Glaucoma NZ now and receive free:

• A Glaucoma NZ membership package containing educational glaucoma pamphlets, a glaucoma DVD, a GNZ identity card and previous editions of the newsletter.

• Information about Glaucoma NZ public meetings held to help people with glaucoma understand their condition and the best treatment of it.

• "Eyelights" newsletter issued free to members three times a year.

Title:
* First Name:
* Last Name:
* Address:
Postcode:
Telephone:
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Email (if applicable):
Do you have glaucoma? Yes No
Do you have a family member
with glaucoma?
Yes No
If yes, please state their
relationship to you.
How did you first hear about
Glaucoma NZ?
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