Registry | Australia Alopecia Areata Foundation

ACT
NSW
SA
QLD
TAS
VIC
WA

ACT
NSW
SA
QLD
TAS
VIC
WA

Get Support
Get Informed
- About Alopecia
  - FAQs
- About AAAF
  - Achievements
  - Our Board
- Research
- Treatments
- Wigs
- Accessories
- RAISE Newsletter
Get Involved
Store
Registry
Contact

Events

<<	May 2019					>>
M	T	W	T	F	S	S
29	30	1	2	3	4	5
6	7	8	9	10	11	12
13	14	15	16	17	18	19
20	21	22	23	24	25	26
27	28	29	30	31	1	2

What is AAAF?

Social Media

4k

656

20

626

Fundraise

Registry

Home
Registry

Please fill in the form below to join the AAAF Registry.
We recommend you use Firefox, Chrome or Edge, if you are having trouble completing this form you can use an alternative one here

Your Name

Your Email

Phone

Address

Suburb Postcode

State

Gender

Date of birth

Do you have a form of Alopecia
YESNO

If so, which type

Does any member of your family have Alopecia

Can your image be used in marketing
YESNO

Do you want to be contacted regarding research trials for your category
YESNO

Do you want to be notified of upcoming events
YESNO

Would you like to be contacted regarding volunteer assistance needed at events
YESNO

Please provide a brief description in what area you would like to help

How did you find out about AAAF

I have read Privacy Policy and Publishing Personal Information and agree to be added to the Registry.

Please prove you are human

Love Alopecia

Donations

$ Donation Amount:

Select Payment Method

PayPal
Credit Card

Personal Info

First Name *

Last Name

Email Address *

Credit Card Info

This is a secure SSL encrypted payment.

Card Number *

CVC *

Name on the Card *

Expiration *

Billing Details

Country *

Address 1 *

Address 2

City *

State *

Zip / Postal Code *

Terms

Personal and health information collected by AAAF is protected under the Privacy Act 1988 (Commonwealth) as amended by the Privacy Amendment (Private Sector) Act 2001 (Commonwealth) including the National Privacy Principles and the Health Records Act 2001(Victoria). AAAF being national in collection, is required also to comply with any other relevant state or territory privacy legislation (the Law).In this policy, a reference to ‘information’ in general is a reference to both personal and health information.

AAAF is committed to protecting your privacy. We respect the privacy of your information, and manage it according to the Law. The Law regulates how your information is handled throughout its life cycle, from collection to use and disclosure, storage, accessibility and disposal.

Show Terms Hide Terms

Agree to Terms?

Donation Total: $5.00

Follow Us

4k

656

20

626

sitemap | registry | donate | Contact us
ABN: 14 104 820 346 Charity Registration No: A0057033E

Designed by Voonix ITS.

Donate Hair

Your Name (required)

Your Email (required)

Comments

Before

After

*filesize is limited to 8MB per image

Please prove you are human

Close