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KEEP YOUR 30% REBATE
 Fill out the form below to tell us your comments on the 30% rebate.

Be an active member of the Keep Your 30% Rebate team today, and help protect your 30% rebate. Indicate whether you would be willing to assist AHIA in actively promoting policies such as the retention of the 30% rebate on private health insurance and other policies that protect your entitlement to choose private health care.

If you choose to subscribe and join the team, we will provide you with regular up-to-date information about private health insurance and health policy, as well as suggesting ways you can help work to keep your 30% rebate. The information you provide will allow health insurance funds that are members of the AHIA to contact you, should your support for private health insurance be necessary. No information will be given out to anyone other than those health funds which are members of the AHIA without your permission.

Mr   Mrs   Miss   Ms  
* First Name:
* Last Name:
* Email Address:
* Postal Address:
* Town/Suburb:
* State: * Postcode:
* Phone Number:
(Including Area Code.)
* Gender: Male    Female
Your health fund:
(Optional.)
I am willing to:
(Please tick one or more boxes.) 		Write letters to newspapers
Write letters to Members of Parliament
Comment on radio stations
Preferred mailing option: Email    Post
Subscribe: Yes     No
* Your comments/suggestions:
We may list your comments on our website and forward them to Members of Parliament to show them how people feel. It would have more impact if we could include your name, postcode and state (but not your residential address).
Do you consent?   Yes    No
 
*Compulsory Field
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