Application for Associate Membership

Preferred Contact Details

Private contact details

Practice contact details

*Surname

*First Name

Title

Do you identify as being of an indigenous background?

Private Contact Details

Address

Country

Telephone

Mobile

*Email

Practice Contact Details

Name of Training Practice

Address

Country

Telephone

Mobile

*MBBS (or equivelant)

Please upload a copy of your MBBS (or equivalent)

*Curriculum Vitae

Please upload a copy of your CV

Declaration

I declare the following

I hereby apply to become an Associate (or Overseas Associate) Member of the Australasian College of Sport and Exercise Physicians and agree to abide by the ACSEP Constitution and Code of Ethics. I agree to pay all annual fees.

*Security Check