Associate Application - Australian Traditional Medicine Society

Please note:

Associate Membership is not a practitioner category and does not confer practitioner status.

1800 456 855 info@atms.com.au Fax (02) 9809 7570

Suite 12/27 Bank St Meadowbank NSW 2114

"*" indicates required fields

First Name*

Last Name*

Have you been known under any other name(s)

Yes

If yes, please state names:

(If your name is different on any of your documents, evidence of legal name change may be required)

Mailing Address*

DOB*

Place of Birth*

Please attach one of the following as a form of identification*

Max. file size: 100 MB.

(Driver's License, Birth Certificate, or Passport)

Please attach photo*

Max. file size: 100 MB.

E-mail For ATMS Use*

Website

Home Telephone

Mobile*

Have you been a previous member of ATMS?*

Yes

If Yes, membership number

Payment Details (The ATMS membership cycle runs from July to June. No pro-rata of fees.)*

Associate Membership July 2025 - Jun 2026 - $100.00

Have you ever been convicted of a criminal offence, had a complaint made against you considered by a complaints or disciplinary body including other associations, been suspended or expelled from another association, or been investigated, suspended or deregistered as a provider from a health fund?

Yes

If yes, Please provide details

Signature*

Date*