2019 HPMI Individual Membership Please complete following form to become a HPMI Member. You MUST answer question re name, contact number and health professionIgnore other questions if your details are unchanged.-----------------------------------------------------------------INDIVIDUAL MEMBERSHIP TYPES - reduced 05/07/2019$350 - GP Membership$275 - AHP Membership (includes Nurses and Administration staff)$350 - Specialist Membership$220 - Registrar Membership$275 - Online Streaming ONLY MembershipCOMPLIMENTARY MEMBERSHIP (click here) AVAILABLE TO Health Students, Interns, RMOs & GP Trainees GROUP MEMBERSHIP (click here) Question Title * 1. Name Title Given Name Surname Question Title * 2. Health profession General Practitioner Nurse Registrar Administrator or Clerical staff Specialist or other Allied Health (please specify) Question Title * 3. Honours and qualifications Question Title * 4. QA or ACRRM (if applicable) Question Title * 5. Email address (please supply for provision of meeting information) Question Title * 6. Phone Nos. Business Mobile (Needed for meeting notifications only) Fax Question Title * 7. Surgery Name and Address Surgery Name: Surgery Address 1: Surgery Address 2: Surgery Address 3: City/Town: State/Territory: Post Code: Question Title * 8. Preferred mail address (if different from above) Address 1 Address 2 City/Town State Postcode Question Title * 9. Associated with: Hunter Primary Care Hunter Surgical Society Next