Application for Admission to Membership – Associate

  • Application for Admission to Membership – Associate

    The Board of the Australasian College for Emergency Medicine (ACEM; the College) may admit as an Associate member, medical practitioners who have completed all the requirements for any of the ACEM approved Associateship Training Programs including associated assessment and administrative requirements.

  • Form No: F912
    Last Revised: January 2025
    Version: v3

  • College Pledge

  • As a condition of membership of the Australasian College for Emergency Medicine, I hereby pledge to conduct myself in accordance with the College’s Core Values of Respect, Integrity, Equity and Collaboration and its governing Constitution, Regulations, Code of Conduct and associated documents.

    In my work and conduct as an emergency medicine practitioner, I will uphold the ethical and professional standards expected of a member of the College and as a member of the medical profession.

  • Personal Details

  • Date of birth*
     - -
  • Are you of Aboriginal or Torres Strait Islander origin?

  • Contact Details

  •  -
  •  -
  •  -

  • Address

  • Mailing address*

  • Qualifications

    Primary Medical Degree already on file.

  • Medical Board Registration Details

  • Other:

  • Continuing Professional Development

    (for those registered to practise in Australia only)

  • Read ACEM's CPD Homes Policy (COR909).

  • Declaration

  • Question 1: Pursuant to the ACEM Constitution and associated regulations, all Associate members are required to hold current medical registration. Do you have any suspension, condition, reprimand, restriction or undertaking, other than those routinely associated with your category of registration, imposed on you by a regulatory authority that affects or limits your having unconditional medical registration in Australia, New Zealand or any other country where you reside or practise?*
  • Question 2: If you answered ‘NO’ to Question 1 above, are you aware of any complaint or other action that may potentially alter your answer to that question?*
  • Question 3: Have you been charged or convicted of a criminal offence (other than minor traffic or other trivial offences)?*
  • Question 4: Are you subject to any restriction or limitation under any mental health law or regulation?*
  • Date*
     - -

  • Annual Subscription Fee

  • Payment of the appropriate Associate annual subscription fee must be paid prior to admission to membership as an Associate. An invoice will be issued once the application has been deemed eligible. The amount payable is calculated according to the following:

    1. the month during which admission to membership as an Associate is anticipated; and
    2. the country in which the applicant is residing and working at the time the application is made.

    Further information on fees and payments is available on the Fees and Payments page on the ACEM website.

    Note that the subscription fee covers the Associate membership to 30 June. Fees are due annually in July.

  • Should be Empty: