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 Secretary.
Secretary: Prof Peter Russell, Douglas Hanly Moir Pathology, 14 Giffnock Avenue, Macquarie Park, NSW 2113 or prussell@dhm.com.au
New membership applications can be made by printing and completing the form below. Send to the Treasurer.
Treasurer: Dr Annabelle Farnsworth, Douglas Hanly Moir Pathology, 14 Giffnock Avenue, Macquarie Park, NSW 2113 or afarnsw@dhm.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 $175 (incl GST). Associate membership, Non-Specialists $145 (incl GST).
New Zealand and Overseas applicants: Subscription fee (Australian Dollars) Specialists $175. Associate membership, Non-Specialists $145
Please make cheques payable to ASCCP and return forms to the TREASURER with cheque. Credit Card facilities also available. Credit card charges 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 $___________________