Australian Pain Society - Member application

APS Contact Information

Should you have any queries, please contact the Secretariat office at 02 9016 4343 or by email aps@apsoc.org.au
APS Secretariat
PO Box 637
North Sydney NSW 2059
Tel: 02 9016 4343 Fax: 02 9954 0666
Email: aps@apsoc.org.au

APS Online Membership Application Instructions

The Australian Pain Society, a registered charity, is a fully constituted not-for-profit association of interdisciplinary professionals with a keen interest in the optimal management of pain for all people throughout life.

As such, membership is not simply a matter of paying a fee to join.

Thank you for respecting the process below.

Step 1: Complete the online form below, noting the mandatory fields.

Step 2: Electronically sign the form using your mouse or finger.

Step 3: After you submit the form, the system will send a copy of the pre-filled membership application form to your primary email address. This form will include your temporary membership number. It is helpful if you add aps@apsoc.org.au to your contacts to ensure you receive our emails.

Step 4: After the APS Membership Committee has approved your application, you will be notified by email and requested to make payment accordingly

Member Information

Title *

First Name *

Last Name *

Age Range *

Gender *

Do you identify as Aboriginal or Torres Strait Islander? *

Post-nominal/Qualification *

Professional Biography Link * (If no Professional Biography link available, please enter 'not applicable'.)

AHPRA Number * (If no AHPRA Number available, please enter 'not applicable'.)

Discipline *

Specific Area of Interest

Primary Contact

Company/Organisation/Institution

Please enter primary contact number or mobile number* (Please include area code)

Primary Contact Phone ( e.g. 03 9999 88xx )

Mobile ( e.g. 0413 999 xxx )

Email (Primary)*

Please enter Email (Primary) again *

Address Line 1 *

Address Line 2

Suburb *

State *

Post Code *

Country *

Work Contact

Tel. (Work)

Fax

Email (Work)

Website URL (Please include http:// or https:// in URL)

TeleHealth URL (Please include http:// or https:// in URL)

Click here if the address is the same as Primary Contact.

Address Line 1

Address Line 2

Suburb

State

Post Code

Country

Home Contact

Tel. (Home)

Email (Home)

Click here if the address is the same as Primary Contact.

Address Line 1

Address Line 2

Suburb

State

Post Code

Country

Optional Selections

Checkboxes select preferences.

I agree to be in the Private Membership Listing. Only APS members can look up my 'Work Contact' details.

I agree to be in the Public Listing. This feature displays 'Work Contact' details on the APS website.

I agree to receive eNewsletters and email updates from the APS.

Membership Type

Choose the correct tier based on your Pre-Tax Gross Income

Note: Pre-tax gross income is the annual income from all the sources, i.e. not only from pain related work.

If you select Student Membership, the following criteria must be met:

Proof of full time student status and annual income/stipend required; and
Annual income within specified limit, as per below

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Special Interest Group

Please check the below box if you wish to join the Special Interest Group

SIG - Pain in Childhood AU $40

SIG - Basic Pain Research AU $40

APS Gift Fund Donation

The Australian Pain Society (APS), an ATO registered charity, works to support PhD Scholarships, pain education and research. Donations over $2 are tax deductible.

Voluntary contribution amount ($)

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Declaration

I consent to be a member of and agree to be bound by the Australian Pain Society's constitution and by-laws

Invalid value

Payment Summary

Membership amount : $

SIG total amount : $

APS Gift Fund Voluntary contribution amount (Over $2 is tax deductible) : $

Total payment amount : $

Review

Membership Application

APS Contact Information

APS Online Membership Application Instructions

Member Information

Primary Contact

Work Contact

Home Contact

Optional Selections

Membership Type

Special Interest Group

APS Gift Fund Donation

Declaration

Payment Summary

Application Summary

Edit the above information

Accept the above information, sign and submit