GPpartners Membership Subscription

Please enter information on the form below to process your application for GPpartners Membership.

Username*

Password *

Retype Password *

Verify Email *

Gender *

Male

Female

Are you a Practice Owner *

Special medical interest areas

Title *

First Name *

Last Name *

Practice Name *

Practice Address

Practice Postcode

Residential Postcode

Phone

Mobile

RACGP No *

Use of contact details *

Confirm Acceptance

I understand that GPpartners may use any or all of the above contact details specified above to communicate with you including any official notices as required under the Corporations Act 2001 and the Gppartners Limited constitution.

Fee Waived *

Confirm Acceptance

I understand the usual subscription fee has been waived until 30 June 2016

Membership Approval *

awaiting

confirmed

Membership Category

Security Code*