Member Assistance Request All member requests are now on the one form. Please submit your request via the form below. If you have any issues completing this form, please email the team at: support@cfact.org.au Member ID *First 4 letters of last name, first initial, YY of birth, DD of birth.First Name *PWCF NameLast Name *PwCF Age Group *Please select an age groupChild (0-16 yrs)Adult (16+ yrs)Service Feedback *Will be used to report to funders by anonymous clients.Email Address *Assistance RequiredReimbursementPurchase ProductsVitABDeckPlease choose all that applyDetails of RequestComplete if seeking reimbursementPlease confirm what the reimbursement is for e.g. sport, medical equipment, nutritional supplements.Complete if seeking the Purchase of Products (including VitABDeck)If you are requesting CF ACT to purchase products, please list as many details including the name and model number.If Purchasing Products, please advise Mailing AddressThis will be where the products are posted to.Upload fileDrag and Drop (or) Choose FilesFor reimbursements, please ensure the receipt is uploaded.Total Cost *AUDTotal amount of member requestConsent *I declare that the information I have provided is true and correct. I authorise Cystic Fibrosis ACT representative(s) to contact my/my child's CF Clinic Team to confirm the items I have requested, support the prescribed treatment plan. I understand that my request for assistance is pending approval and needs to be considered by the Management Committee and is subject to available funding.E-Signature * Submit