Member Application

SPASM Membership Application/Renewal

Type of Membership?

FULL MEMBER

CORPORATE MEMBER

LIFE MEMBER

DONATION

Full Name (Dr, Ms, Miss, Mrs, Mr)

Postal Address

Suburb/Town

State/Territory

Postcode

Contact Phone (+ Area Code)

Contact Email

Current Position

Hospital or Organisation

PLEASE NOTE

After submitting this form you will be directed to a screen which outlines how to pay your membership fee.