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Membership Form - Associate Membership

Thank you for your interest in becoming an Associate Member! For information about membership benefits, click here.

To apply, simply follow the instructions and complete the form below.

Instructions:

Fully complete each step (Step 1 to 3) before submitting the form
The current Associate membership price for the year (1st April 2024 to 31st March 2025) is $400.00. Pro-rata rates apply from October 2024.
Remember to attach your Curriculum Vitae.
NOTE: If you are unable to submit the form (i.e. error message "Email address already exists"), please contact the Secretariat (secretariat@anzsom.org.au)
Membership applications are forwarded to the relevant state branch for consideration / approval (up to two weeks to process).
Once approved, the Secretariat will send you a link to pay your membership online. You will have the option of paying via EFT or credit card.
Once payment has been provided, the Secretariat will send you a letter of approval and member log-in details.

Complete your details (steps 1 to 3):

Step 1 - Contact Details
Step 2 - Areas of practice & expertise
Step 3 - Public Directory

Title

Firstname

Surname

NOTE: If error message appears "Email address already exists", please contact the Secretariat (secretariat@anzsom.org.au)

Organisation

Occupation

Other Occupation

Preferred Contact Number

Preferred Mailing Address

Suburb

State

Postcode

Country

If Other Country

AHPRA registration number (if applicable)

Curriculum Vitae

Languages spoken (other than English)

Pandemic expertise

Workplace pandemic planning / workplace policy

Personal protective equipment

Facility management

Ergonomics / working from home advice

Mental health impacts

Sickness absence and return to work

Coronavirus (COVID-19) campaign resources

Training

Areas of Practice

Alcohol and other drugs / medical review officer

Biological monitoring / chemical exposure

Early intervention programs

Employee Assistance Program

Environmental health / safety management systems / risk assessments

Fitness for work assessment

First aid

Health promotion / wellness programs

Health surveillance

Independent medical examination/ medico-legal

Injury management/ workplace rehabilitation

Musculoskeletal health / ergonomics

Occupational lung disease

Pre placement and exit health assessments

Prescribed fitness for duty health assessments (rail, commercial vehicle drivers, marine pilots, firefighters etc)

Task analysis / dictionary of job requirements

Travel health / Q fever immunisation

Workers compensation, claims management and financial risks

Vaccinations

Industry Expertise

Aviation

Agriculture

Agriculture, forestry and fishery

Construction

Education

Emergency services

Healthcare

Manufacturing

Oil, gas and mining

Pandemic

Transport other

Retail and hospitality

Underwater diving

Other (please specify below)

Other industry expertise

I agree to be listed in the 'Find an Expert' directory

Yes

This allows members of the public to search for you and your business using the 'Find an expert' function. If Yes - please complete all details below.

I agree to be listed in the 'Find a member' directory

Yes

This is a member-only page and allows current ANZSOM members to search for other members. Your email, phone and occupation will be listed.