Exam Form

UIP Online Training Application

Fill out the form carefully to apply for the ACP Online Education Modules.
Enrolment in the online modules does not provide membership with the Australasian College of Phlebology or enrolment in the full clinical training program.

There is no clinical training provided through the online modules and a certificate of completion will be received on completion of all modules for each level of training (Years 1, 2, 3 & 4).
Full Name*

First NameLast Name
Applicant E-mail*
example@example.com
Mobile Number*

Country CodeArea CodePhone Number
Postal Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Upload Proof of Medical Registration*
Are you a member of the ACP, UIP or UIP Member Society?*
Name of your Member Society*
Upload Proof of UIP Membership. This can be a letter from your member society that is an approved UIP society memebr or from the UIP.*
Access Type
$2,200.00 AUD
$1,590.00 AUD
Free - proof of membership and residency is required
Fee

Payment Amount

AUD

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

UIP Online Training Application