NASOG Membership Application Form

Name *

Prefix First Name Last Name Suffix

Email *

example@example.com

Phone Number *

Area Code Phone Number

Mailing Address *

Address Line 1

Address Line 2

City State

Post Code

Organisation

Department

Position

Work Phone Number

Area Code Phone Number

Alternative Contact

First Name Last Name

Alternative Contact Phone

Area Code Phone Number

Alternative Email Address

example@example.com

Please verify that you are human *

Select Your Membership Category and Make Payment *

Specialist O&G $ 600.00 AUD

Full membership for specialist Obstetricians and Gynaecologists

AGES Member $ 500.00 AUD

Discounted membership for specialists who are current members of AGES.

GP Obstetrician $ 300.00 AUD

Membership with all benefits for GP Obstetricians

Supporter $ 300.00 AUD

For those who wish to support NASOG's advocacy work but not receive any benefits of membership.

New Fellow $ 300.00 AUD

Discounted rate for full membership benefits to support new fellows in their first 2 years of practice.

Retired Member $ 200.00 AUD

Rate for members who have retired from practice to continue to show support for NASOGs advocacy work.

Trainee/Student $ 27.27 AUD

Subtotal $ 0.00 AUD Tax $ 0.00 AUD Total $ 0.00 AUD