Membership Application Form - UFS Pharmacies

Where can I use my card?Regional Pharmacies*Bacchus Marsh25-27 Grant St 5367 2134Ballan129 Inglis St 5368 1232Ballarat717 Sturt St 5331 981140 Bridge Mall 5327 040069 Victoria St 5333 1959Beaufort62-64 Neill St 5349 2504› Skipton Depot 5340 2105› Willaura Depot 5354 1373Buninyong316 Learmonth St 5341 2121Delacombe830 Latrobe St 5336 0100Golden Point515 Main Rd 5331 4806Melbourne Pharmacies*Brunswick WestFairfield228 Melville Rd 9386 6113Coburg501 Sydney Rd 9354 1068UFS MedicalBridge Mall Medical CentreLevel 1, 40 Bridge Mall, Ballarat5327 0420Sturt Street Medical Centre1008a Sturt St, Ballarat 5331 2522Peace & Quiet719 Sturt St, Ballarat 5332 1694www.peaceandquiet.bizMelton CentralCentral Walk Shopping Centre415-429 High St 9743 9080Melton SouthStation Square Shopping Centre11 Station Rd 9743 3533Mt ClearMidvale Shopping Centre1172 Geelong Road 5330 2644Sebastopol56 Albert St 5336 0455Tarneit939 Sayers Road 8742 7255Wendouree1207 Howitt St 5339 6933132 Station St 9481 0289Pascoe Vale76 Cumberland Rd 9354 9032Doveton St Medical Centre202 Doveton St Nth, Ballarat5364 9100www.ufsmedical.com.auCherub Cards & Gifts727 Sturt St, Ballarat 5333 3611www.cherubgifts.com.auUFS Administration206 Armstrong Street Nth Ballarat, VIC 3350P: (03) 5327 7700 F: (03) 5332 7565 E: members@ufs.com.au*Voting rights are restricted to individual Friendly Society membership. All regional pharmacies are owned and operated byUFS Dispensaries Ltd. Brunswick West, Coburg and Pascoe Vale pharmacies are owned and operated by Friendly Pharmacy (Vic) Ltdand managed by UFS Dispensaries Ltd. Fairfield pharmacy is owned and operated by North West Dispensaries Friendly Society Ltd andmanaged by UFS Dispensaries Ltd.historyUFS Dispensaries is a not-for-profit community health care organisationwhose core business is to provide affordable and accessible pharmacy,medical and related health care services to our members. UFS is managedby a Board of Directors which is made up of representatives of the broadercommunity.UFS Dispensaries is based in Ballarat. Pharmacy locations are spreadacross the western region including Beaufort, Ballan, Bacchus Marshand Melton. UFS operates two community-service pharmacy depotsat Skipton and Willaura. Other business units including UFS Medical,Peace & Quiet, Cherub Cards & Gifts and Treloar’s Coffee House arelocated in Ballarat.UFS was formed in 1880 with the first dispensary opening in 1881.Since then 14 other pharmacies have opened. UFS Medical and Treloar’sCoffee House were established in 2008, Peace & Quiet in 2004 and CherubGifts in 1998. UFS also manage four pharmacies in Melbourne for FriendlyPharmacy (Vic) Ltd and North West Dispensaries Friendly Society Ltd.pharmacies open lateBallarat (717 Sturt Street)Weekdays 8.00am to 8.00pmSaturday 9.00am to 5.00pmSunday 9.00am to 5.00pmBacchus MarshWeekdays 8.30am to 8.30pmSaturdaySundayCoburg9.00am to 1.00pm10.00am to 1.00pmWeekdays 9.00am - 9.00pmSaturday 10.00am - 9.00pmSunday 9.00am - 8.00pmMelton CentralWeekdays 9.00am to 7.00pmSaturday9.00am to 3.00pmMelton SouthWeekdays 9.00am to 8.00pmSaturdaySunday9.00am to 5.00pm10.00am to 2.00pmUFS MembersSave 7.5%with Australian Unitybecome a member> more benefits than you thinkUFS membership is for everyone.Everyone who wants health carewith attractive discounts and accessto convenient services.Version UFS_02 Sep 2011

member applicationPrimary Card Holder DetailsTitle Mr Mrs Miss Ms Dr First Name Last NamePostal Address Town State PostcodeD.O.B. Phone (Home) Mobile Email1 Year Membership $10 2 Year Membership $20I hereby make application to become a member of UFS Dispensaries Ltd (ABN 49 087 822 259) and agree to be bound by the Constitution of the Company.I understand UFS Dispensaries is a not for profit company limited by guarantee.Signed ______________________________________ Date ______/______/______Spouse / Partner DetailsFirst Name Last Name Sex Date Relationship Email Address Mobile Number Card BabyM/F of Birth to member Required ClubDependant Detailshow to joinTo join as a new member, simply complete this MembershipApplication and return it with the appropriate fee to any UFSPharmacy listed overleaf. Alternatively, you can mail to theRegistered Office at PO Box 301, Ballarat 3353.annual subscriptionThe present membership fee is $10 each year (or $20 for 2 years) and is payablewhen joining as a new member.Protecting Your PrivacyUFS Dispensaries collects membership information for the purposes of administering membership,mailing MemberCare News and other member information. Should you not wish to receiveMemberCare News, please write to PO Box 301, Ballarat 3353 or call (03) 5327 7700. Theinformation collected is obtained from the Membership Application, is not passed on to any thirdparty, and is treated in accordance with wishes expressed by members at the time of joining orrenewing their membership.Please tick to receive:1) Notices of meetings of UFS Dispensaries (including A.G.M)2) UFS Dispensaries’ Annual ReportInterestsPlease indicate your interest areas to ensure we send offers and informationof benefit.I am interested in:Promotions and SpecialsWomen’s HealthFashion and New TrendsMen’s HealthGift GivingChildren’s HealthMassage and Beauty Therapies Weight ManagementFragrance and SkincareQUIT SmokingBaby CareNatural HealthFitness and Exercisemember benefitsMost members are attracted to the savings, but there is much moreto gain from your UFS membership.member discounts• UFS Pharmacies - SAVE 20% off all retail prices and private prescriptions (exceptPBS prescriptions, boutique cosmetics, hire or community benefit items sold at cost)• UFS Medical - UFS members receive 10% discount off the gap payment for GPconsultations, plus there is also the added benefit of 10% discount off physiotherapyconsultation fees and 20% discount off all physiotherapy products. Healthcare cardholders may also receive discounted consultations.• Peace & Quiet - SAVE 10% off services at our wellbeing centreand 15% off products• Cherub Gifts - SAVE 15% off all retail prices• Treloar’s Coffee House - SAVE 20% off all retail prices• Miss Devine Makeup Artistry - SAVE 10% on services at the Bridge Mall Pharmacy• Australian Unity - SAVE 7.5% on health insurance for UFS Membersmember servicesSome services are provided to members FREE of charge, others are atdiscounted prices.• UFS Baby Club - Maternal & Child Health Nurse• UFS Medical Women’s Health Clinics• Ear Piercing• Weight Management Programs• Healthcare Equipment Hire• MemberCare News mailed three times yearly• Free delivery in urban areas of Ballarat, Bacchus Marsh and Melton for memberswho require special assistance or urgent prescription pick up and deliverydiscounted tickets at Her Majesty’s TheatreMembers are able to buy discounted tickets to most productions on presentationof your UFS card at MajesTix in Ballarat.reciprocal benefitsFriendly Society Dispensaries are situated throughout Australia and most will honouryour membership card entitling you to a discount (see www.ufs.com.au for a full list ofother pharmacies).membership cardsYour membership card will be posted to you after joining as a new member.This process usually takes a few weeks. Your partner and dependant children under 18years (full-time student children under 25 years) are entitled to discount, and can applyto receive their own card. A dependant adult requiring full-time care is also able toregister as a dependant. We require membership cards to be presented for scanningwhen commencing any transaction.membership renewalEach year you are required to renew your membership (unless you have subscribed fora two year period). Renewal notices will be sent out the month prior to yourmembership falling due and when paid, your membership will be valid for 12 months(or two years) from your renewal date.Printed on 100% recycled stock (ReArt art paper)