Member Registration

Membership Level change

You have selected the Emeritus, Honorary or Regent Members level.

Emeritus, Honorary or Regent Members are nominated by the council and do not pay annual fees.

The price for membership is $0.00 now. Customers in Australia will be charged a 10% GST.

Account Information Already have an account? Log in here

Username *

Password *

Confirm Password *

First Name *

Last Name *

Email Address

Confirm Email Address

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

Full Name LEAVE THIS BLANK

Australian Residents
Check this box if your billing address is in Australia.

Additional Information

Qualifications *

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

Area of speciality *

Areas of Interest *

Are you already an existing member of ANZHS? [yes/no]*

Please upload your CV in pdf format *

ANZHS member nominating membership application: *

ANZHS member seconding this membership nomination: *

Place of Practice – Australian and New Zealand members only

Practice / Hospital name

Address 1

Address 2

City

State / Region:

Postal Code

Billing Address

First Name *

Last Name *

Address 1 *

Address 2

City *

State *

Postal Code *

Country *

Phone *

Payment Information We accept all major credit cards

Card Number

Expiration Date

CVC

Join our mailing list.

ANZ Headache Society

Terms of Use

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.

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).

If you do not wish to be included please tick here.

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.

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.

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