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Individual Prefix *

Last Name *

First Name *

Gender *

Female Male Other

Birth Date *

Registration Number *

Please enter
AUS: Australian Health Practitioner Regulation Agency Registration Number
NZ: New Zealand Medical Council Number
Overseas: Please provide relevant medical registration number/s

Primary Email *

This email address will be used for all society correspondence sent to you. Please check your webmail provider’s spam/junk mail settings to ensure you receive ANZSGM emails about your membership.

Secondary Email *

This email address will be used as a back up means of contacting you in the event that we are unable to contact you on your primary email address.

Mobile Phone *

Work Phone

Address *

City *

Postcode *

Country *

State *

Present employment position *

Place of Work *

Work Street Address *

Work City *

Work Country *

Work Postcode *

Work State *

Please note, if your membership application is successful, you will be able to add additional qualifications to your profile.

Qualification Name *

Please enter 'MBBS' or 'MBBS Equivalent'

Year Awarded *

Awarding Institution *

If you are currently undertaking FRACP, please select which year of study you are in

Additional Qualifications *

Please enter the Qualification Name, Year Awarded & name of Awarding Institution

Membership Type Requested *

Full Membership
Full Membership status will be granted to medical practitioners who are committed to clinical practice, research, education and administration in geriatric medicine and closely allied disciplines. The requirements for full membership shall be prescribed by the Council from time to time as it sees fit.
Trainee Membership
Trainee Membership status will be granted to individuals who are medical practitioners currently registered in a training program in geriatric medicine and related disciplines.
Associate Membership
Associate Membership status will be offered to applicants for membership who are general practitioners with an interest in geriatric medicine.
Overseas Membership
Overseas Membership will be granted to individuals who are registered medical practitioners primarily resident in places other than Australia and New Zealand who demonstrate a commitment to clinical practice, research, education and administration in geriatric medicine and closely allied disciplines.

Membership Proposed by *

Your membership application must be proposed by an existing Full Member of the Society. Trainees or Associate members are ineligible to be your proposer. Please ensure you have secured a proposer as we will need to confirm this as part of our review of your application.

Would you like to join the ANZSGM Society Directory?

Yes No

The Society Directory is a free and exclusive tool for ANZSGM members to find and engage with other members. Members can search this directory to find members by name, location and expertise.

This information is not made public and is available to ANZSGM Members only

Acknowledgment of Membership *

I seek Membership of the Society in the category indicated above

I confirm I am seeking membership of the ANZSGM in the category indicated above. I acknowledge that upon my admission to membership, I will be bound by the Rules of the Society as in force from time to time.

Become an ANZSGM Member

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