Membership Renewal Form

 

MEMBER RENEWAL PRICES 2018 (GST Inclusive)

Ordinary Member $275.00

Registered nurses and enrolled nurses working in the field of mental health.

Maternity Leave $110.00

For applicants who are on maternity leave (maximum of 12 months). Please attach confirmation of maternity leave status from your employer.

Fellow Member $275.00

By application after 5 years continuous membership.

Retiree $110.00

For applicants who are no longer working.

Associate Member $220.00

For applicants who have a special interests in the mental health field and who are not otherwise eligible for the Ordinary Member category.

Student Member $110.00 (maximum 4 years)

For full-time undergraduate nursing students or RNs enrolled in a full-time postgraduate course with relevance to mental health nursing. Evidence of current full-time enrolment must accompany applications and renewals. Other full-time students may apply for special consideration.

Personal Details

Please note: All fields marked with (*) are required. This form will not be accepted without these fields being completed.
Type of Renewal
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Member Number
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Title(*)
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First Name(*)
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Surname(*)
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Date of Birth(*)
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Gender
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Mailing Address

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Mailing Address 1(*)
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Mailing Address 2
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Suburb(*)
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State(*)
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Postcode(*)
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Contact Details

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Home Telephone
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Personal Mobile
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Personal Email
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Work Phone
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Work Mobile
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Work Email
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Preferred Contact by
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Professional Details

Place of Practice
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Other (please specify)
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Primary Work Focus
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You have completed the mandatory section of this form. The remaining section is optional, however the College would appreciate your input as your answers provide important demographic information that the College uses to better serve its members. If you do not wish to enter any more information - simply press the Submit button at the bottom of this form.

Employment Details

Employer
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Address
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Suburb
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State
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Postcode
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Professional Details

Nursing registration number issued by AHPRA. Your registration number should start with NMW and be followed by 10 digits:
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Primary practice setting
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Other (please specify)
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Regional location
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Other (please specify)
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Current fields of practice: Click to view examples
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Primary Position Title Click to view examples
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Academic & Professional Qualifications
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Research Interests & Experience
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Are you interested in being a member of the Primary Mental Health Care Special Interest Group?
Are you interested in being a member of the Consultation Liaison Special Interest Group?
Are you interested in being a member of the Perinatal & Infant Mental Health Special Interest Group?
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Are you interested in being a member of the Aboriginal & Torres Strait Islander Special Interest Group?
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Are you interested in being a member of the Clinical Supervision Special Interest Group?
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Are you interested in being a member of the Older Adults Special Interest Group?
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Before you submit this application - please do ensure that you have filled out all the fields above marked with this symbol (*).
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