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MSGV membership application form


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Please contact us if you would prefer us to post out a printed application form.


 


Apply for membership

Help us to help you – join the Ménière’s Support Group of Victoria today!
To join the MSGV you need to complete a membership application form and post it to us together with your fee payment.

Member survey

If you are joining the MSGV - or you are already a member - please take a few minutes to complete the following online member survey. All information is optional. Any information you can provide will help us to improve and better target our services to members. We will not pass on your personal information to other parties without your consent.

(Mr/Mrs/Ms/Miss/Dr)
 
How long have you been a member of the Ménière’s Support Group of Victoria?
I have just applied for membership
Less than 1 year
1-5 years
over 5 years
   
I joined/want to join the Ménière’s Support Group of Victoria because:
I have Ménière’s disease
A family member or friend has Ménière’s
I have a professional interest in Ménière’s
   
Fill out the following sections only if you have Ménière’s disease. If you have only filled in the above section, please remember to click the 'Send' button at the bottom of this form.
What symptoms do you experience?
Vertigo (dizziness)
Hearing loss
Tinnitus (abnormal noise in the ear)
Sensitivity to sound
Anxiety/emotional issues
   
I am under the care of:
GP (local doctor)
Ear Nose & Throat (ENT) Specialist
Neurologist
   
I have had surgery for Ménière’s:
No
Yes
   
Thanks for providing us with this valuable information.

   

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