Membership
Categories of membership are defined in the Constitution: Ordinary Members, Associate Members, Honorary Members.
The Society currently has about 250 members. Information about Membership can be obtained from the Secretariat.
New membership applications can be made by printing and completing the form below and sending to:.
ASCCP Secretariat: YRD, PO Box 717, Indooroopilly, QLD, 4068, Australia.
P 07 3368 2422, F 07 3368 2433, mary@yrd.com.au
Australian Society for Colposcopy and Cervical Pathology Inc.
ABN 25 773 381 323
APPLICATION FOR MEMBERSHIP
SURNAME ...........................................................................................................................................
FIRST NAME ............................................................................................TITLE................................
QUALIFICATIONS .............................................................................................................................
POSTAL ADDRESS ............................................................................................................................
.............................................................................................................................................................
.............................................................................................................................................................
BUSINESS PHONE ( ……)..........................................................
PRIVATE PHONE ( ……)...........................................................
FAX ( ……)..................................................................................
EMAIL ......................................................................................... (For newsletters, etc)
HOSPITAL AFFILIATIONS ..............................................................................................................
.........................................................................................................................................................
STATUS ..........................................................................................................................................
(e.g. Gynaecologist, Pathologist, Non-Specialist etc)
SIGNED ……………………………………………………
DATE ………………………………………… PLEASE KEEP YOUR DETAILS UP TO DATE
Australian applicants: Subscription fee (Australian Dollars) Specialists $185(incl GST). Associate membership, Non-Specialists $155 (incl GST).
New Zealand and Overseas applicants: Subscription fee (Australian Dollars) Specialists $185. Associate membership, Non-Specialists $155
Please make cheques payable to ASCCP and return forms to the Secretariat with cheque.
ASCCP Secretariat:
YRD,
PO Box 717, Indooroopilly, QLD, 4068, Australia.
P 07 3368 2422, F 07 3368 2433,
mary@yrd.com.au
Credit Card facilities also available.
Credit card charges 2.5% apply.
(Fees may be subject to change).
Card Type: O Mastercard / O Visacard
Card No. ___ ___ ___ ___ / ___ ___ ___ ___ / ___ ___ ___ ___ / ___ ___ ___ ___
Expiry Date ___ / ___
Card Verification No.(last 3 digits on signature panel of credit card) ___ ___ ___
Card Holders Name _________________________________________________
Signature__________________________________
ASCCP Membership Fee $___________________