Student Membership Application

STUDENT

Membership Application
Name*

PrefixFirst NameSurname Name
Please attach photo*

Cancelof
Postal Address*

Street Address

Street Address Line 2

SuburbState

Postcode
E-mail:*
example@example.com
Home Telephone (for ATMS office use only)
Mobile:
Birth Date:*

DayMonthYear
Country of Birth *
Gender*

FemaleMale
Do you have residency or permit to work in Australia ?

YesNo
Have you been known under any other name(s)

YesNo
If yes, please state names:
(If your name is different on any of your documents, evidence of legal name change may be required)
Rejoining ATMS
Have you been a previous member of ATMS? *

YesNo
If Yes, membership number
College Enrolment / Qualification Details
Name of qualification being undertaken *
Name of teaching institution you are attending*
Address of teaching institution you are attending
Date studies commenced*

DayMonthYear
Expected completion date*

DayMonthYear
Do you authorise ATMS to contact your college on your behalf to confirm enrolment or other study details?

YesNo
(NOTE: PLEASE ATTACH PROOF OF CURRENT ENROLMENT.)*

Cancelof
Additional Information
How did you hear about ATMS?*

ATMS Presentation/MaterialCollege LecturersYour practitioner/friendsSocial Media/Internet
Other (Please specify)
Checklist

Evidence of current enrolment (NOTE: Letters of Offer or student ID cards are NOT considered sufficient evidence.)Passport sized photograph of yourselfProof of legal name change, if your name is different on any of your documentation.
Have you ever been convicted of a criminal offence, had a complaint made against you considered by acomplaints or disciplinary body including other associations, been suspended or expelled fromanother association, or been investigated, suspended or deregistered as a provider from a health fund?*

YesNo
If yes, Please provide details
I declare that the information in this application and supporting documentation is true and correct. I agree to abide by the ATMS
Constitution, Code of Conduct and official ATMS policies.
Signature

Clear
Print Name
Date

DayMonthYear
Should be Empty:

STUDENT