Member Online Application Australia Member Application AU To complete your membership application to the Australian Society Of Cytology online, as quickly and easily as possible, you will already have a copy of your qualification certificate scanned and saved on your computer; ready to upload to us, Your Visa or MasterCard on hand to enter your details. Title --- Select -- Dr Mrs Ms Miss Mr Last Last Name Name First Name Date Of Birth * (Click inside box) Laboratory * (Laboratory or workplace name) State * --- Select -- South Australia Victoria ACT New South Wales Queensland Western Australia Tasmania (State You Work In) Landline Phone Mobile Phone Address Address Address Address Suburb Suburb State State Postcode Postcode Email (Please enter your email address) Qualifications * Bachelor (Science) Masters (Science) CTASC CTASC (Gyn) CTASC (NGyn) FASC PhD MBBS MD FRCPA Institution Of Highest Qualification * (Name Of University etc.) Year * (Year Obtained) Cytology Experience * (Please include experiences with time frames) Proposer And Seconder (Must be either Medical or Non-Medical financial members of the Society) Proposer Contact Phone Seconder Contact Phone Categories Of Membership Medical (Specialist) $270 Members are specialists who are registered medical practitioners who engage in the practice of Cytology. Medical (Registrar) $205 Members are registered medical practitioners who engage in the practice of Cytology. Non Medical $205 Members are graduates of a degree course in Medical Laboratory Science (or equivalent) from a recognised tertiary institution, or persons who hold the CT(ASC) who are not registered medical practitioners but who engage in the practice of Cytology. Associate $135 Members are persons interested in Cytology not eligible to be Medical or Non-Medical members. (Note: 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.) Please Also Note A once off New Members Joining Fee of $55 is also charged (and for past members who's membership has lapsed for more than 4 years). How Would You Like To Join Us? * Medical Specialist Medical Registrar Non Medical Associate Current Membership Status * --- select --- I'll be a new member I am a current member My membership expired 1 year ago My membership expired 2 years ago My membership expired 3 years ago My membership expired 4 years ago My membership expired 5+ years ago Hard Copy Cytoletter Posted ($20) * Yes Please Post No thank you Total in AUD Including G.S.T. Attach Bsc/Phd Qualification * Drop a file here or click to upload Choose File Maximum upload size: 8MB Payment (Your credit card will only be deducted if your membership application is successful) Security Protocols adopted by this website: If you look in the browser window at the top of the screen, you will see a padlock. The website has a 2,048 bit encryption SSL by Comodo™. Credit Card Type * Visa Mastercard Name On Card * Card Number * Card Number Card Number End Month 1 2 3 4 5 6 7 8 9 10 11 12 End Month End Year 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 End Year On back of card On back of card Acknowledgement * I accept (By checking this box, and clicking submit below, you acknowledge the information is true and correct in every way and that if your membership to the Australian Society Of Cytology Inc. is successful, your credit card will be deducted for the amount shown in total.) Submit If you are human, leave this field blank.