IAP Membership

Surname:

Given Names

Postal Address:

e-mail address:

Main Practice Address:

Other Practice Addresses:

Main Practice Telephone and Fax:

Hospital(s) associated with:

Qualifications (and year):

Sub-specialty and professional interests:

Hobbies:

Home Address, telephone and fax (optional):

Any areas the Institute should pay attention to?

Please attach copies of your registration, qualifications and 2 professional references and a cheque* made to the Institute of Australasian Psychiatrists and send to:

Full member: AUD$200

Associate member: AUD$100

Semi-retired member: AUD$100

Retired member:AUD$50

Overseas member: AUD$50

Associate membership is available for psychiatric trainees and other medical practitioners. For details, contact Dr Leslie Lim by snail mail or e-mail to leslie_lim@iap.org.au