Australian Society of Cytology - Pursuit of Excellence
Australian Society of Cytology

Application for Membership

Please complete and send this form with the appropriate fee to:

   Australian Society of Cytology Inc,
   PO Box 491,
   North Adelaide SA 5006

Personal Details

Title (Dr/Mrs/Ms/Miss/Mr):
Name:
Residential Address:
 
Phone:
Fax:
Place of Employment:
Work Address:
 
Phone:
Fax:
Preferred Postal Address:
Email Address:

Professional Details

Please attach COPIES of qualifications to your application

Qualifications (eg MBBS,CTASC)
Institution
Year






Cytology Experience

Proposer and Seconder

Must be either Medical or Non-Medical financial members of the Society and known to the applicant

Proposer:  Signature:_____________________________________
Seconder: Signature:_____________________________________

Application and Declaration

I apply for the following class of membership (please check):

MEDICAL Registered medical practitioners who engage in the practice of Cytology
Total $157 - (entrance fee $20, annual subscription $122.73, GST $14.27)
NON-MEDICAL Graduates of a degree course in Medical Laboratory Science (or its equivalent) from a recognised tertiary institution or persons who hold the CT(ASC) or an equivalent qualification, who are not registered medical practitioners but who engage in the practice of Cytology.
Total $157 - (entrance fee $20, annual subscription $122.73, GST $14.27)
ASSOCIATE Persons interested in Cytology not eligible to be Medical or Non-Medical members. Associate members do not have the right to vote in the affairs of the Society, but may participate in all other activities of the Society.
Total $112 - (entrance fee $20, annual subscription $81.82, GST $10.18)
  Note: Applicants from overseas are not required to pay GST.

On acceptance a confirmation letter incorporating a tax invoice will be sent.

Signature: _____________________________________
Date:

Payment Details

Bank Cheque Money Order  - made payable to Australian Society of Cytology Inc.
     
Visa Mastercard
     
Amount:  
Card Number:   - - -
Card Verification Code (If Applicable)  
Expiry Date:   /
Card Holder's Name:  
     
Card Holder's Signature:   _____________________________________

 

 

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