SCT Combined Membership Application

  • SCT Membership Application

  • Are you;*
  • Were you previously qualified outside of NZ?*

  • Personal Details

  • Date of Birth*
     / /

  • Current Employment Details

  • Current Position Start Date*
     / /

  • New Members/Change in Membership

  • Membership Type*

  • Current Employment Details

  • Technician Procedures Performed;*
  • Physiologist Procedures Performed;*
  • Have you previously qualified to work as a Physiologist?*

  • Work History

  • Clinical Competency

    Please select procedures you have performed in the last 5 years of your previous employment.
  • Technician Procedures Performed;*
  • Physiologist Procedures Performed;*
  • Training Completion Date*
     / /

  • Education

    Please include transcripts for your qualifications. Multiple files can be uploaded in each box.
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  • Renewal

    If your membership with SCT has lapsed you are required to complete this form.
  • Membership Type*

  • Returning to Work

    Please refer to the Return to Practice Guidelines available on the SCT website for more information.
  • Are you applying as a;*

  • Return to Work - Physiologist

  • Education

    Please include transcripts for your qualifications. Multiple files can be uploaded in each box.
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  • Clinical Competency

    Please select procedures you have performed in the last 5 years of your previous employment.
  • Technician Procedures Performed;*
  • Physiologist Procedures Performed;*
  • Training Completion Date*
     / /
  • Last date of employment;*
     / /

  • Return to Work - Technician

  • Education

    Please include transcripts for your qualifications. Multiple files can be uploaded in each box.
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  • Previous Experience

    Please select procedures you have performed in the last 5 years of your previous employment.
  • Technician Procedures Performed;*
  • Last date of employment;*
     / /

  • Payment Info

  • If your membership application is successful, you will be sent an invoice for SCT membership of $150.
    If your return to work application is successful, you will be sent an invoice for the exam fee of $500.
    If your international membership application is accepted pending passing the international certification examination, you will be sent an invoice for the exam fee of $500.

  • Declaration

    • I declare that the statements I have made are accurate.
    • I declare to be governed by the rules & regulations of the society and advance the objects of the Society.
    • I agree to inform the society immediately of any change in circumstances which may affect my right to continue as a member of the society.
    • I consent to be a Member of the Society.
    • I agree to promptly advise the Society of any change to my name and/or contact details.

    A copy of this response will be forwarded to the charge physiologist at your place of work for approval. If your application is succesesful, we will be in contact regarding payment of membership fees.

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