Membership Form

URO-

GYNAECOLOGICAL

SOCIETY of

AUSTRALASIA

UROGYNAECOLOGICAL

SOCIETY OF AUSTRALASIA

C/- UGSA Secretariat, College House
254-260 Albert Street
East Melbourne
Victoria 3002 Australia

E-mail: dobrien@ranzcog.edu.au

Please click in adjacent box if you do not wish to receive emails about UGSA meetings

Amount [$AUD}

Occupation

Receipt will be forwarded from RANZCOG

Type the word in the space above

Declaration: [To accept, please click in the adjacent box.]

I apply to become a Member of the above named Society. In the event of my admission as a Member/Associate Member, I agree to be bound by the Constitution and Rules of the Society for the time being in force.

Membership Type:

Category A: Full Membership [incl IUGA]

Fee: $Aud 300.00 [incl GST]

Category B: Certified UroGynaecologists and Fellows of RANZCOG and Urogynaecology Pelvic Surgery Online Database

Fee: $Aud 500.00 [incl GST]

Category C: Associate Membership

Allied Health Professionals, Students, Sub-Specialty Trainees, Consumers.

Fee: $Aud 120.00 [incl GST]

Category D: Associate Membership + Database

Fee: $Aud 320.00 [incl GST]

Membership fee may be paid ‘online’ or the membership form may be downloaded by clicking the following link and faxed or posted.

Membership Form for download

State

ABN: 34 100 268 969

Membership category: A or B or C or D

First name

Last name

Address

Address (continued)

Town/City

Country

Postcode

Daytime telephone

Mobile telephone

E-mail address

Cardholder's name

Card number

Security code

Type of card

Expiry date

Issue number if required

MEMBERSHIP APPLICATION FORM

On receipt of payment this form becomes a TAX INVOICE for GST.

UGSA

Click here

For

UGSA

Constitution

Rules