Registration – SUPER Course | St Leonards, NSW | 1 August 2026
Please tell us about yourself. If you require any assistance completing this form, please reach out to membership@acem.org.au.
Full Name
*
Dr
Professor
Associate Professor
Mrs
Mr
Ms
Miss
Mx
Prefer not to say
Title
First Name
Last Name
Position
*
Organisation
*
City
*
Country
Email
*
example@example.com
Phone
*
Are you attending virtual or face-to-face?
*
Virtual
Face-to-face
Membership
For CPD purposes, please answer the following questions.
Are you an ACEM member?
Yes
No
Is ACEM your CPD Home
Yes
No
ACEM ID Number
Membership Category
*
ACEM Fellow
Retired Fellow
Associate
Certificant
Diplomate
Advanced Diplomate
International Affiliate
Educational Affiliate
Trainee
Non-member - CPD Home
Please select the best category:
Nurse or Registered Nurse
Allied Health Professional
Community Member
Medical Trainee
Medical Doctor
Prevocational Doctor
Privacy
I understand that photography and filming may take place at this event, and that images or footage may be used by the organisation for promotional purposes on its website and social media channels.
Yes, I understand
The Privacy Act 2001 provides that, before your personal contact details can be captured and made available to ACEM and other parties directly related to the event, you must give your consent. The College privacy policy can be found
here
.
Yes, I give consent
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