Australian College of Psychological Medicine
Membership
Membership Services
Membership Application Print

Applications for Membership of the Australian College of Psychological Medicine are invited from all medical practitioners, who are currently registered in Australia. The granting of membership is at the discretion of the executive committee. Please complete the form below.

Alternatively you can download a pdf version of the application form and post it to:
Australian College of Psychological Medicine, GPO Box 1979, Sydney 2001
or fax to 1300 888 606.

Fields indicated with a * are required fields.
Application Type *
Title *
Surname *
Given Names *
Address *
City *
State *
Postcode *
Country *
Phone - Home
Phone - Work
Phone - Mobile
Fax
Email *

Qualifications

Please provide FULL NAME (not initials only) of any degree or diploma and of the institution and YEAR of graduation.

Primary medical qualifications (if applicable)
Other undergraduate qualifications:
Postgraduate qualifications
Clinical interests
Languages spoken
Current practice
Type of practice, approximate hours worked including hours spent in psychological medicine:
Please send me information brochures about the College: *

Please send the following to the address below when using this online application:

  1. Photocopy of current Australian medical registration document if joining as a full member
  2. Payment using one of the following options. Please indicate which option you will be using. *

Cheque: If paying by cheque please make it payable to Australian College of Psychological Medicine.
Direct Deposit: If you prefer to pay by online EFT please contact the College ( This e-mail address is being protected from spambots. You need JavaScript enabled to view it or 1300 888 606) for bank account details for transfer.
Credit card: If you wish to pay by credit card (Visa or Mastercard) please post details to Australian College of Psychological Medicine, GPO Box 1979, Sydney 2001 or fax a document to the College, 1300 888 606. Please include the name and number of the card, the expiry date, and the amount being paid.
Fees
Annual membership (financial year): $225.00
If joining between October and December: $175.00 for that year
If joining between January and March: $125.00 for that year
If joining between April and June: $75.00 for that year
I am interested in participating in the following College activities: