NASOG Membership Application Form

Name *

Prefix First Name Last Name Suffix

Email *

example@example.com

Phone Number *

Area Code Phone Number

Mailing Address *

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