Australian Society for Psychological Medicine
Membership

Membership Application

Applications for Membership of the Australian Society for Psychological Medicine are invited from medical practitioners who are currently registered in Australia and others with an interest in mental health. The granting of membership is at the discretion of the executive committee. Please complete the form below.

Alternatively you can pdfdownload a pdf version of the application form and post it to:
Australian Society for Psychological Medicine, PO Box 4098, Homebush South NSW 2140
or fax to (02) 9660 8830.

Membership Application Form

Application Type*
Please select an application type

Title*
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Surname*
Please enter your surname

Given Names*
Please enter your given names

Address*
Please enter your address

City*
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State*
Please select your state

Postcode*
Please enter your postcode

Country*
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Phone (Home)
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Phone (Work)
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Phone (Mobile)
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Fax
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Email*
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Qualifications

Please provide FULL NAME (not initials only) of any degree or diploma and of the institution and YEAR of graduation.

Primary medical qualifications
(if applicable)
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Other undergraduate qualifications
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Postgraduate qualifications
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RACGP/ACRRM No.
(if applicable)
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Clinical interests
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Languages spoken
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Current practice
Type of practice, approximate hours worked including hours spent in psychological medicine:
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Please send me information brochures about the Society *
*
Please indicate if you would like to receive Society brochures

Please send the following to the address below when using this online application:

  1. Photocopy of current Australian medical registration document if joining as a full member
  2. Payment using one of the following options. Please indicate which option you will be using.
I will be paying by*
Please indicate which payment method you will be using

  • Cheque: If paying by cheque please make it payable to Australian Society for Psychological Medicine and post to PO BOX 4098 Homebush South, NSW 2140.
  • Direct Deposit: If you prefer to pay by online EFT please use the following bank transfer details:
    • BSB: 082204
    • Account No.: 587862637
    • Please use your surname as the identifier.
  • Credit card: If you wish to pay by credit card (Visa or Mastercard) please post details to Australian Society for Psychological Medicine, PO Box 4098, Homebush South NSW 2140 or fax a document to the Society, (02) 9660 8830. Please include the name and number of the card, the expiry date, and the amount being paid.
Fees
Annual membership (financial year): $300.00
If joining between October and December: $250.00 for that year
If joining between January and March: $200.00 for that year
If joining between April and June: $150.00 for that year
Retired Members $125.00  
I am interested in participating in the following Society activities:
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