Title
Given Name :
Surname :
Username (Username must be first initial then surname in lowercase e.g jcitizen)
Password
Address 1
Address 2
Address 3
Address 4
Town
State
Postcode
Country
Phone
Mobile
Fax
Email
Degrees
Area Of Interest Select : Anaesthetist Endocrinologist General Obstetrics Haematologist Intensivist Maternal-Fetal Medicine Midwife Midwife Diabetes Educator NotSelected Obstetric Physician Obstetrician Obstetrician & Gynaecologist Physician Scientist Scientist, Obstetrician
College(s)
Awards, Grants, Fellowships
Display In Member Directory - Please tick box if you wish to allow other SOMANZ members to find your contact details in the member only directory.
You must have a nominator who is current financial member of SOMANZ OR provide a copy of your current CV to support application if you do not know a SOMANZ member. If neither (Nominator details and/or CV) information is included; your membership application will NOT be considered by the Council.
Nominators Name
Nominators Email Address
Upload CV (Microsoft Word or pdf only)
Membership Type : Select : Full Student Full International Student International Scientist Scientist International Allied Health Allied Health International - Please select International if residing outside of Australia. This will remove the GST component of your fee.
