DR magazine sign up form

Print Magazine sign up form

Subscribe to receive the Dermatology Republic magazine
Name *

First Name Last Name
Delivery Address *

Street Address

Street Address Line 2

City State / Territory

Postcode
Phone Number *
For contacting if there are delivery issues.
Email *
Also subscribe to the e-newsletter?

Yes, please No, thank you
AHPRA number
This publication contains content intended solely for medical professionals. We need to verify your AHPRA number is current and matches your name
Don't have an AHPRA number?

I'm a medical student I'm a retired doctor I work in medical advertising I work in the medical industry Other
What type of healthcare professional are you?

Medical dermatologist Surgical dermatologist Cosmetic dermatologist Pediatric dermatologist Dermatopathologist Immunodermatologist Dermatology nurse Dermatology registrar GP Other AHPRA-registered healthcare professional Other medical industry professional
What interests you in the field of dermatology?

Skin cancer Allergy Skin-related autoimmune diseases Cosmetic dermatology Acne vulgaris Vitiligo Cold sores Warts Hives / Uticaria Shingles / Herpes Zoster Ichthyosis Eczema / Atopic dermatitis Contact dermatitis Psoriasis Rosacea Dry skin Melasma Infectious disease Rash Sunburn Athlete's foot Alopecia areata Rare skin disorders Paediatric dermatology Inflammatory skin conditions Occupational skin disorders Hair and nail disorders Pigmented disorders Other
Should be Empty:

Print Magazine sign up form