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Membership Application Form
Membership year covers the 12-month period 1st July to 30th June. Interested people are welcome to join at any time of the year however please note that no discount is applied to the membership fee, and the expiry date will remain 30th June
*
Indicates required field
WHAT CLASS OF APPLICATION IS THIS ?
*
Renewal of ordinary membership ($80.00)
New ordinary membership application ($80.00)
Renewal of corporate membership ($80.00)
New corporate membership application ($80.00)
Renewal of student membership (Free)
New student membership application (Free)
Title
*
Name
*
First
Last
ORDINARY OR CORPORATE MEMBER DETAILS
Occupation
*
WORKPLACE
*
STUDENT MEMBER DETAILS
Student – Program of study
*
Place of Study
*
Upload a copy of your student card
*
Max file size: 20MB
Free student applications are only processed once a copy of your student card has been uploaded
Email
*
Phone Number
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Professional Interests
*
PLEASE NOTE
Your application will need to be approved at our management committee meeting, witch are held on the 3rd Wednesday of each month
Submit
Home
About Us
About Us
Advocacy
Our Committee
Governance
Newsletter Subscription
Corporate Sponsorship
Contact the Society
Meetings
Clinical Meetings
One off Attendance
RSVP
AGM
Membership
Membership
Membership Application Form
ASHM’s Affiliate Program
ASHA
Journal Access
Scholarships
Scholarships
Far North Queensland RN Virtual Conference Scholarship
Far North Queensland RN Conference Scholarship
SHSQ Virtual Conference Scholarship
SHSQ Conference Scholarships
Members Clinical Meeting Scholarship