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
3) Review, Declare & Print
4) Payment

* 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 with a minimum 2 years experience

The following documentation will need to be provided:

*	Registered Nurse Certificate (min 2 years)
*	Appropriate further qualifications such as: Graduate Certificate in Cosmetic Nursing or the Graduate Diploma of Cosmetic Nursing or ACCS (Australian College of Cosmetic Surgery) Cosmetic Nursing Certificate or equivalent qualification
*	Current AHPRA registration certificate
*	Two letters of reference required from colleagues, one being a medical doctor
*	Current Medical Indemnity Insurance certificate
*	Current certificate of Cardiopulmonary Resuscitation (CPR) 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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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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You can upload up to 5 files (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

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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 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.

Save & Exit

Submit

Contact Information
ACAM Secretariat
Ph: + 612 9016 4183
Fax: + 612 9954 0666
E-mail: secretariat@acam.org.au
Postal address: PO Box 637 North Sydney NSW 2060 Australia

Other Information
All fees are in AUD and GST is included
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Membership Application Form is Loading...

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

{{myForm.qualificationText}}

Medical Specialty

{{myForm.medicalProcedureText}}

Declaration

Medical Registration Number ^*

Application Type^*