Australasian College of Aesthetic Medicine (ACAM) Membership Application Form

Membership Application Form

1) Personal & Contact Details
2) Other Details
3) Document Upload
4) Review, Declare & Print

* Mandatory fields

Please click here to find out about the terms and conditions, and the fee information about the membership

PLEASE NOTE category open to Registered Nurses ONLY

The following documentation will need to be provided:

*	Current AHPRA registration certificate

Full Member

Fellow

Cosmetic Nurse

Personal Details

Title

First Name ^*

Middle Name

Last Name^*

Postal Address

Company/Practice Name

Address Line 1^*

Address Line 2

Suburb^*

State

Please specify

Postcode

Country^*

Primary Contact Details (Include International & Area Codes)

Phone^*

Mobile

Email Address for Login ^*

Re-enter email address ^*

Other Email Address

I would like my contact details available to other members

Primary Practice Address

Tick if its the same as the Postal Address

I would like my practice location listed in the public viewing 'Find a Doctor' area of the website (additional clinics can be added in the member area)

Company/Practice Name

Website Address (please include http:// or https:// in website URL)

Address Line 1

Address Line 2

Suburb

State

Please specify

Postcode

Country

Medical Registration Number ^*

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Please specify

Medical Specialty

Please tick the box below. You can tick more than one.

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Other

Please specify

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Please tick the box below. You can tick more than one.

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Upload files (max 10 MB each file) for each category.
You have entered the following details

Application Type^*

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Personal Details

Title
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First Name ^*
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Middle Name
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Last Name^*
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Postal Address

Company/Practice Name
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Address Line 1
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Address Line 2
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Suburb
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State
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Please specify
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Postcode
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Country
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Primary Contact Details (Include International & Area Codes)

Phone^*
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Mobile
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Please note that your email address will be your username to login to the member area.

Email Address ^*
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Other Email Address
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Primary Clinic Address

I would like my practice location listed in the public viewing 'Find a Doctor' area of the website (additional clinics can be added in the member area) - {{myForm.OptInPubliclist|checkBoxConvert}}

Company/Practice Name
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Website Address
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Address Line 1
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Address Line 2
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Suburb
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State
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Please specify
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Postcode
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Country
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Medical Registration Number

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Other - {{myForm.QualificationsGrp[999999]|checkBoxConvert}}

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Medical Specialty

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Other - {{myForm.SpecialtiesGrp[999999]|checkBoxConvert}}

Please specify - {{myForm.SpecialtyOtherVal}}

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{{item.Procedure}} - {{myForm.ProceduresGrp[item.ProcedureId]|checkBoxConvert}}

Declaration

I understand that I am applying for ACAM Nurse Membership. ACAM is an aesthetic medicine representative body with a focus on adult education and learning, and the ethical practice of aesthetic medicine. As such, my educational activates are required to be logged on my CPD dashboard and may be subject to a random audit. I understand that it is a requirement of membership that I am adequately insured for the procedures that I conduct. If there is a change in my registration status I am obligated to inform the college. I agree to the terms and conditions of the College. I agree to the terms and conditions of the College.
Your application has been saved. You can come back later to continue. If you need any further assistance, please contact our office.
Thank you for your application to join the Australasian College of Aesthetic Medicine (ACAM). Your application will be reviewed and we will be in touch with you over the coming week to confirm your details.

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Contact Information
ACAM Secretariat
Phone: +612 9167 9398
E-mail: secretary@acam.org.au
Postal/Secretariat address: Australia Square - Level 33, 264 George St, Sydney NSW 2000 Australia

Other Information
All fees are in AUD and GST is included
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Personal Details

Postal Address

Primary Contact Details (Include International & Area Codes)

Primary Practice Address

Medical Registration Number *

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Medical Specialty

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You have entered the following details

Application Type*

Personal Details

Postal Address

Primary Contact Details (Include International & Area Codes)

Primary Clinic Address

Medical Registration Number

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Medical Specialty

{{myForm.medicalProcedureText}}

Declaration

Medical Registration Number ^*

Application Type^*