Membership Application

To become a member of the AWRGPN:

Read the Membership Charter and Terms of Use.
Choose Membership Type
Either complete the online Membership Application at the bottom of the page or print out the Membership Application Form and send or fax to:

Albury Wodonga Regional GP Network
PO Box 168
Wodonga VIC 3689
Fax: 02 6049 1999

Types of Membership

There are three types of membership:

FULL MEMBER

A General Practitioner who:

practices in the geographic area serviced by the Albury Wodonga GP Regional Network
has practiced in the geographic area serviced by the Albury Wodonga GP Regional Network, but has retired from practice
supports the objects of the Network

is eligible to be a full member.

ASSOCIATE MEMBER

Any person who:

works in the geographic area serviced by the Albury Wodonga GP Network in a General Practice (including a community health centre), specialist medical practice or health service organisation
lives and works in the geographic area serviced by the Albury Wodonga GP Network
supports the objects of the Network
is not eligible to be a full member

is eligible to be an associate member.

GEOGRAPHIC AREA

The geographic area serviced by the Albury Wodonga GP Network is the area covered by the following local government areas;

· Albury City

· Corowa

· Culcairn

· Holbrook

· Hume

· Urana

· Wodonga City

Online Application

Membership Type
Membership type (see definitions):*	Full Membership Associate Membership
Annual report preference
	I wish to receive an Annual Report
I wish to help save our environment and join the AWRGPN email list
	Join mailing list
Personal Details
Surname:*
First Name:*
Home Street Address:*
Gender:
Date of Birth:
Telephone Number:*
Email:*
Specialty/Practice Interests:*
Practice Details
QA and CE Number:*
Provider Number:*
Practice Name:*
Practice Street Address:*
Practice Telephone Number:*
Conditions
I have read and agree to comply with the terms and conditions outlined above.
	I agree

* Required