Request edit access
JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
ACIIDS Membership Application
The Australian Chronic Infectious and Inflammatory Disease Society (
https://www.aciids.org.au
) is a
group of medical and health practitioners looking for the underlying causes of chronic illness, utilising a healing-oriented medicine approach that takes account of the whole person, including all aspects of lifestyle. ACIIDS
emphasise
the therapeutic relationship between practitioner and patient, are informed by evidence, and makes use of all appropriate therapies.
ACIIDS offers two membership options:
Full Membership
Open to doctors and dentists
First year introductory cost $120 ($240 per year thereafter)
Associate Membership
Open to nurses, nurse practitioners, naturopaths, and other allied health professionals (psychologists, dietitians, nutritionists, chiropractors, osteopaths etc.) who have completed an accredited tertiary course and have work experience in integrative/holistic/functional medicine.
First year introductory cost $110 ($220 per year thereafter)
Benefits of membership
Access to the ACIIDS email list where you can ask questions and share case studies with some of Australia's leading integrative health practitioners.
Access to new ACIIDS webinars, every six to eight weeks
Savings on the ACIIDS annual conference.
Access to the member area of the ACIIDS website where you can access webinars and other materials dating from 2014.
Voting privileges at the annual general meeting (full membership only).
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Are you a registered medical/dental practitioner or another type of health practitioner?
*
Medical Practitioner
Dental Practitioner
Nurse/Nurse Practitioner
Naturopath
Allied Health (please specify in Other)
Other:
GENERAL INFORMATION
Name
*
Your answer
Date of birth
*
MM
/
DD
/
YYYY
Phone (office)
Your answer
Phone (mobile)
*
Your answer
Practice (street address)
Your answer
Practice (suburb)
*
Choose
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
Practice (postcode)
Your answer
QUALIFICATION INFORMATION
University or school attended
*
Your answer
Qualification attained
*
Your answer
Year attained
*
Your answer
Medicare provider/Health practitioner license number
*
Your answer
Other qualifications
Your answer
SPECIAL INTEREST INFORMATION
Special interest areas
*
Your answer
CONSENT TO BE A MEMBER
I (a) consent to become a member of Australian Chronic Infectious and Inflammatory Disease Society Limited; and (b) agree to comply with the constitution of the company provided to me on the date of this consent
Type name
*
Your answer
Date
*
MM
/
DD
/
YYYY
Your application will be sent to the board for approval. If approved you'll be emailed details for payment. Please email
support@aciids.org.au
with any questions.
Send me a copy of my responses.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report