Are you a practicing headache physician? [yes/no]:-

Select

Area of specialty:-

Select

Area of interest:-

Place of Practice - Australian and New Zealand members only

Practice / Hospital name:-

Address 1:-

Address 2:-

City / Suburb:-

State:-

Postcode:-

Terms of Use

Not Ticked

Not Ticked

• I undertake to support the purposes of ANZHS and agree to comply with the rules of and regulations of ANZHS.
• I understand that all membership applications are considered by the committee prior to approval.
• I allow ANZHS to communicate via email. I will endeavour to keep ANZHS updated regarding my best email address for this purpose.
• Specifically, I consent to ANZHS emailing me about participation in research trials.
• Please tick this box if you do not consent to this.

• Please tick this box if you do not consent to this.

• Specifically, I consent to ANZHS emailing me about participation in headache education.

Not Ticked

• Some of your contact details maybe included in a members directory. This would be visible to other ANZHS members only. Details would exclusively include your name, practice location, specialty/role and nominated email address (if you would like to share this).

• Please tick this box if you do not consent to this.

Not Ticked

• Your name, nominated email, specialty and practice location may be shared with ANZHS associates.

• Please tick this box if you do not consent to this.

Not Ticked

• Please tick if you would like to be included in a publicly available specialty registry of practitioners with an interest in headache. Specifically, your name, specialty and practice location will be visible. No other personal data would be used.