CSSANZ | Changes to my Membership

Changes to my Membership
Please complete this form only if any of the following apply:

I have retired from active colorectal practice and all other colorectal specialty appointments.

I wish to apply for Ordinary Member – Overseas status (requires proof of overseas appointment).

I wish to apply for Ordinary Member – Non Practicing status (requires proof of temporary leave or continuation with colorectal research, academic, or teaching appointments).

I wish to resign my Membership.
If you have any questions regarding this form, please contact the CSSANZ Office via email cssanz@cssanz.org or call (+61 3) 9853 8013.
PERSONAL DETAILS
First name:
LAST NAME:
Your email:
example@example.com
Your Mobile / Phone contact
Format: (000) 000-0000.
Membership Change
What changes would you like to make to your CSSANZ Membership?
Upload proof of temporary leave or continuation with colorectal research, academic or teaching appointments.

Please name your file "LAST NAME First Name - Supporting Documents" eg SMITH John - Supporting Documents.
Cancelof
Upload proof of overseas appointment.

Please name your file "LAST NAME First Name - Supporting Documents" eg SMITH John - Supporting Documents.
Cancelof
Should be Empty:

Changes to my Membership