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NEW APPLICATION TO JOIN
RENEWAL OF ANNUAL MEMBERSHIP
Hospital/Practice/ Self - employed
Preferred Postal Address
Phone (work hours)*
Please tell us a little about yourself
How would you describe your current role?
Rehabilitation Medicine Trainee (currently registered with AFRM)
Practicing Rehabilitation Physician
Retired from Clinical Practice
If other, please specify
If a Fellow of the Australasian Faculty of Rehabilitation Medicine, what is your Fellowship number?
In what year were you granted Fellowship?
If you have any areas of special interest, please tick the appropriate boxes:
Spinal Cord Injury & Disease
Traumatic Brain Injury
Prosthetics & Orthotics
Illness and Injury in Older People
Medico - Legal
If other special interest, please specify
$385 - Ordinary Membership (GST Inclusive) if payment is received before 1 September
$440 - Ordinary Membership (GST Inclusive) if payment received after 1 September
$110 - AFRM Trainees (GST Inclusive) if payment is received before 1 September
$121 - AFRM Trainees (GST Inclusive) if payment is received after 1 September
$200 - Associate Membership (GST Inclusive)
FREE - for Retired AFRM Members
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