Join MAPW "*" indicates required fields Step 1 of 2 50% Membership*Select your membership tier. Membership is valid for 12 months. Membership fees are inc. GST. Emerald $35 Sapphire $110 Opal – Most Popular – $248 Silver $400 Gold $600 Platinum $1100 Student FREE I support the aims of the MAPW and agree to abide by the constitution*You can download the MAPW constitution here. I agree to abide by the constitution I am a health professional*Retired health professionals and health students should select ‘yes’. Yes No Where do you study?*Name of your school or university What is your course or field of study?*e.g Nursing, Social Work, MD What year of study are you in?* Please select your profession*Retired health professionals should select previous field. Allied HealthGPNursePhysicianPaediatricianPsychiatristPsychologistPublic HealthSocial WorkerSurgeonOtherEnter your profession or fieldRetired health professionals should enter previous field. AffiliationsPlease select all that apply. ACEM ACRRM ACTM AFPHM AMA ANMF ANZCA CICM RACGP RACP RACS RANZCP RDAA Other Please enter your affiliations AffiliationsIf you’re member of a student group, union, body, or campaign, please let us know. How did you hear about MAPW?* I’m an exisiting or prior member Someone referred me Social media Other TitleOptionalDr.Ms.Mr.Mx.Prof.Assoc. ProfProf. Em.NoneOtherName* First Name Second Name Surname Postnominals Enter your title Date of birth* Day Month Year Primary Email*Enter your primary email address. Your personal email address is best. Secondary EmailEnter your secondary email address if you have one. This could be your work or university email. Home Address* Street Address Address line 2/Traditional Place Name e.g Naarm, Ngunnawal Country. City Postcode Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands State or territory*ACTNSWNTQLDSATASVICWA Your membership feeYour membership is valid for 12 months from the day you join. Easy RenewalMake membership renewal easy! Check this box to authorise auto-renewal in one year. Yes, auto-renew my membership Credit CardPlease check if you have activated a Stripe feed for your form. EmailThis field is for validation purposes and should be left unchanged.
