Membership

This form is to sign up for membership for the following member networks:

After you have completed this form, you are eligible to register for events on the CESPHN website.

If you wish to apply for membership with:

St George Division of General Practice, please contact Silvana Marangoni on 0413 133 041 or education@silvanamarangoni.com
Sydney Health Community Network, please click here

If you are not a general practitioner or allied health professional and wish to attend CPD events, please click here for the CESPHN Events Pass.

Membership Information

Type *

Membership Product *

If you are unsure about which membership you are eligible for, please click here.

Contact

First Name *

Last Name *

Year of Birth *

Gender *

Job Title

Languages that you’re able to practice in

Mobile Number *

Work Email Address *

Personal Email Address

Organisation

Organisation Name *

Organisation Email Address

Organisation Type *

Website

Business Phone *

Business Fax

Organisation Address

Suburb *

Street *

State *

Postcode *

Additional Information

ACRRM Number

QA/CPD Number

Personal information is collected for the purpose of administering our CPD and membership program and communicating with members and event attendees. Data will be shared with your respective member company. CESPHN will manage your data in line with our Privacy Policy, which complies with the Privacy Act 1988 (Cth) and the Health Records and Information Privacy Act 2002 (NSW).