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* 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:
Personal Details
Postal Address
Primary Contact Details (Include International & Area Codes)
Primary Practice Address
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Medical Registration Number *
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Please tick the box below. You can tick more than one.
Medical Specialty
Please tick the box below. You can tick more than one.
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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.
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You have entered the following details
Application Type*
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Personal Details
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{{myForm.FirstName}}
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{{myForm.LastName}}
Postal Address
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{{myForm.PrimarySuburb}}
{{myForm.PrimaryStateId|getState}}
{{myForm.PrimaryStateOther}}
{{myForm.PrimaryPostCode}}
{{myForm.PrimaryCountryId|getCountry}}
Primary Contact Details (Include International & Area Codes)
{{myForm.PrimaryPhone}}
{{myForm.PrimaryMobile}}
Please note that your email address will be your username to login to the member area.
{{myForm.PrimaryEmail}}
{{myForm.OtherEmail}}
I would like my contact details available to other members - {{myForm.OptInMemberlist|checkBoxConvert}}
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}}
{{myForm.PracticeBusinessName}}
{{myForm.Website}}
{{myForm.PracticeAddressLine1}}
{{myForm.PracticeAddressLine2}}
{{myForm.PracticeSuburb}}
{{myForm.PracticeStateId|getState}}
{{myForm.PracticeOtherState|getState}}
{{myForm.PracticePostCode}}
{{myForm.PracticeCountryId|getCountry}}
Medical Registration Number
{{myForm.qualificationText}}
Other - {{myForm.QualificationsGrp[999999]|checkBoxConvert}}
Please specify - {{myForm.QualificationOtherVal}}
Medical Specialty
Other - {{myForm.SpecialtiesGrp[999999]|checkBoxConvert}}
Please specify - {{myForm.SpecialtyOtherVal}}
{{myForm.medicalProcedureText}}
Declaration
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Your application has been saved. You can come back later to continue. If you need any further assistance, please contact our office.
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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.