Register – Iraqi Health Professionals Association

To register as a Standard Member: You must be a medical or health professional and have completed the Australian registration requirements and paid the membership fee for the current year (membership fee: $50)
To register as an Honorary/Student Member: You must be a retired medical or health professional aged more than 65 years or a student currently enrolled in an undergraduate course leading to a medical or allied health degree in the future. Registration is subject to the approval of this application by the IHPAA Board (membership fee: free)
To register as an Associate Member: You must be a medical or health professional who does not fulfill all the requirements for Standard or Honorary/Student membership (membership fee: $50)

Application Form

Type of membership applied for: *

Current Status *

Specialty/Field *

e.g., paediatrician, ophthalmologist, physiotherapist, psychologist

Professional Field (select one) *

Name *

First

Last

Sex *

Birthplace *

Date of Birth *//

Address-1 *

Address-2 *

Suburb *

State *

Postal code *

Phone *

format: +61 (xx) xxxx-xxxx (for land line) or +61XXXXXXXXXX (for mobile)

Email *

Confirm Email

Comment or Message

Please limit the comment to one-line text

Captcha *

What is 7+4?

Phone

To complete the registration process, please pay the registration fee of $50 by Visa Card, Master Card, or American Express, through Paypal: