Associate Membership Application Form

Please complete this form

  • General Practice, Physiotherapy, etc.
  • (main place of work)
  • In accordance with the definition and requirements of the Summit Health Constitution I apply for Associate Membership.

    Privacy Statement: Adelaide Hills Division of General Practice, trading as “Summit Health” is bound under the Privacy Act 1988, and takes reasonable steps to collect, store and use personal or business specific information in accordance with the Organisations’ Privacy Policy.