Update Your Details

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AUSTRALIAN MEDICAL ASSOCIATION (WA)

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Update Your Details

This page allows you to update us with your current practising/contact details.

Personal Details

Preferred Title:*

Surname:*

Given Names:*

Member Number:

Email Address:*

Mobile Phone:*

Please provide the name under which you are registered as a practitioner. Your Member Number appears on the top of your invoice. A confirmation email will be sent to the address you provide here.

Contact Details

Private Address:

Phone:

Fax:

Practice Address 1:

Phone:

Fax:

Practice Address 2:

Phone:

Fax:

Practice Address 3:

Send Mail To:

Private AddressPractice 1Practice 2Practice 3

Current Employment

Type of Practice:*

Other:

Where Employed/Practising:

Other:

Employment/ Practice Commitments:

Other:

Specialty:

Sub-Specialty:

AMA Craft Group:

Please ensure all above information is correct prior to submitting.

* Required

AUSTRALIAN MEDICAL ASSOCIATION (WA)

HOME | ABOUT US | CONTACT US | Login