Membership > Individual Membership for GPs 

Individual Membership for GPs

 

Application for Individual Membership GP Class

 
Please complete all mandatory fields marked with an *
 
Personal Details  
 *
*
*
*
   
*
 
Email
*
 
Mobile
*
 
Clinical Practice
*
   
   
   
   
 
Special Interests (please tick relevant fields)








 
Membership Consent
Agreement By submitting this application, I agree to accept the Constitution of the ACT Medicare Local.
 
Health Services Directory
(Personal details will not be provided)
 
ACT Health Services Directory

Please do not include my details in the ACT Health Services Directory.