2025 Member Exemption/Concession Application Form

CPD exemption and financial exemption or concession
Form No: F696
Approved: July 2025
Last Revised: July 2025
Version: v6
Applicant details
Name:*

First NameLast Name
ACEM ID:*
Contact email:*
Which exemption or concession are you seeking:*
Please refer to the relevant ACEM policy(ies) prior to submitting an application (refer to links below).
Period of application notation

Financial exemptions and concessions are considered in line with the financial year (1 July to 30 June). Applications must be applied for each financial year not later than 31 December.
Period of application notation

CPD exemptions are considered in line with the CPD Year (calendar year). Applications for CPD exemption from six to less than nine months leave will be considered for a six-month exemption; applications from nine to twelve months leave will be considered for a twelve-month exemption.
Period of application notation

Financial exemptions and concessions are considered in accordance with the financial year (1 July to 30 June). Any application for financial exemption or concession must be applied for each financial year not later than 31 December in the relevant financial year.

For CPD exemptions, applications are considered in accordance with the CPD Year (calendar year). In addition, applications for CPD exemption from six to less than nine months leave will be considered for a six-month exemption; applications from nine to twelve months leave will be considered for a twelve-month exemption.
Period of application start date:*

DayMonthYear
Period of application end date:*

DayMonthYear
Period of application start date:*

DayMonthYear
Period of application end date:*

DayMonthYear
Period of application start date:*

DayMonthYear
Period of application end date:*

DayMonthYear

CPD grounds
Exemption from CPD requirements will be considered in accordance with the grounds outlined in the Policy on Exemption from ACEM CPD Program.
The College many grant a financial exemption on the grounds outlined in the Policy on exemption from the ACEM CPD Program (CPD499).
Please select the ground upon which this application is being made:*

I am experiencing prolonged and/or incapacitating illness.I am taking leave arising from pregnancy, parental leave or carer leave, or other leave covered by anti-discrimination law.I am no longer in active clinical practice and am seeking a procedural skills exemption.I am undertaking full-time study.I will be traveling for an extended period.I am a Fellow of another specialist medical college.
I also require a procedural skills exemption as I am no longer in active clinical practice
Please contact me to discuss other ways ACEM may be able to support me.
For applications for CPD exemption on the ground of Dual Fellowship/Fellowship of another specialist Medical College, we recognise that you may not be able to provide evidence of Fellowship at this stage. In that case, please enter 'TBC' in the field below, and the CPD Team will contact you at a later date to request further evidence. Please note that your application will not be processed until evidence is able to be obtained.
Please select the specialist medical college of which you are a Fellow*
Please select the specialist medical college of which you are a Dual Fellow*
If other, please specify*
Please attach your evidence*

Cancelof
Please include any further information in support of your application:
Special considerations/Exceptional circumstances

CPD exemption

The College may grant a temporary exemption for circumstances outside the stated grounds. Such requests should be made in accordance with the provisions of the ACEM Exceptional Circumstances and Special Consideration Policy and will be considered on an individual basis.

Please note:

If you have completely and permanently retired from practice as a specialist emergency physician, including related activities such as teaching and examining, please complete the Declaration Concerning Retirement from Practice as a Specialist Emergency Physician.

Financial grounds
The College may grant a financial exemption or concession on the grounds outlined in the Membership Subscriptions Policy (COR823).
Please select the ground upon which this application is being made:*

I am experiencing incapacitating illness and will not be practise any form of medicine for the whole of the financial year.I am working solely in a humanitarian or similar voluntary field where the income is considered relatively low.I am residing outside Australia or Aotearoa New Zealand on a permanent basis or for a continuous period of not less than 12 months.I am taking leave resulting from pregnancy, parental leave or carer leave, or other leave covered by anti-discrimination law.I am working part-time (clinical; 20 hours or less per week) following or arising from pregnancy, parental leave, or carer leave (or other leave covered by anti-discrimination law).I am working part-time (non-patient contact; 20 hours or less per week) in a role involving activities such as teaching of medical students or a policy/advisory/research role, but which does not involve patient contact in a clinical capacity.I am undertaking full-time study and either taking unpaid leave or not working for the whole of the financial year.
Please contact me to discuss other ways the College may be able to support me.
Please attach your evidence

Cancelof
Please include any further information in support of your application:
Special consideration/exceptional circumstances

Financial exemption or concession

The College may grant an exemption or concession outside the stated grounds in exceptional circumstances; including compassionate leave, extended leave due to illness, reduced capacity to work and financial hardship. Please contact the ACEM Finance Team (accounts@acem.org.au) to discuss requests for financial exemption or concession outside the above grounds. Requests will be considered on an individual basis.

Please note:

If you have completely and permanently retired from practice as a specialist emergency physician, including related activities such as teaching and examining, please complete the Declaration Concerning Retirement from Practice as a Specialist Emergency Physician.

Declaration
I declare that the information that I have provided in this application is true and correct.
I acknowledge that this application must undergo consideration by the relevant ACEM staff and/or College entity(ies).
I understand that the College may require further information from me before a decision can be made in relation to my application for exemption or concession.
I understand that applications for CPD and/or financial exemption or concession must be submitted each year, unless otherwise indicated in relevant College policy or where ACEM has waived this requirement.
I acknowledge that I have read and understood the relevant ACEM policy(ies) related to my application (refer to Policy on exemption from the ACEM CPD Program (CPD499), Policy on re-entry to practice following a period of absence (CPD307) and Membership Subscription Policy (COR823) below, as applicable).
Policy on exemption from the ACEM CPD Program (CPD499)

Policy on re-entry to practice following a period of absence (CPD307)

Membership Subscription Policy (COR360)
I undertake to advise the ACEM Chief Executive Officer via ceo@acem.org.au immediately should circumstances arise that may alter my eligibility for an exemption.
Signature*

Clear
Should be Empty:

CPD exemption and financial exemption or concession

Applicant details

CPD grounds

Financial grounds

Financial and CPD grounds

Declaration