Member Account

E-mail to be visible in members directory and/or ANZHS associates:-

Additional Information

Qualifications:-

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

Select

Area of specialty:-

Select

Area of interest:-

Practice / Hospital name:-

Address 1:-

Address 2:-

City / Suburb:-

State:-

Postcode:-

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.

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

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

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.