Associate Membership

Complete online form below:

    Please select if applicable
  • (for sms event reminders)
  • (please list)
  • (please list)
  • (main place of work)
  • General Practice, Physiotherapy etc.
  • (##) #### ####
  • (##) #### ####
  • (please list)
  • On average, how many hours per week do you work in General Practice in the Adelaide Hills?

    (if applicable)
  • In accordance with the definition and requirements of Summit Health constitution; I hereby apply to become an Associate Member, defined as: "interested persons including interns, registrars, non-General Practitioner health service providers, Allied Health professionals, specialist medical practitioners and General Practitioners residing but not practising in the region" and according to the Privacy Statement below.
    Privacy Statement, Adelaide Hills Division of General Practice, trading as “Summit Health” is bound under the Privacy Act, and takes reasonable steps to collect, store and use personal or business-specific information in accordance with the organisations’ Privacy Policy.