2020 HPMI Group Membership Please complete following form to become a HPMI Group Member. You MUST answer question re Surgery name and contactIf you have not already done so please contact Tracy Hicks to discuss Group Membership 02 4913 8163 or email Tracy.Hicks@newcastle.edu.au-----------------------------------------------------------------COMPLIMENTARY MEMBERSHIP (click here) AVAILABLE TO Health Students, Interns, RMOs & GP Trainees INDIVIDUAL MEMBERSHIP (click here) Question Title * 1. Surgery Details Surgery Name Contact Person Name Contact Email Address Question Title * 2. Surgery Name and Address Surgery Name: Surgery Address 1: Surgery Address 2: Surgery Address 3: City/Town: State/Territory: Post Code: Question Title * 3. Phone Nos. Business Fax Question Title * 4. Preferred mail address (if different from above) Address 1 Address 2 City/Town State Postcode Next