Life Member by ADNA Admin | Dec 15, 2021 Price: Free First Name:* First Name Required Last Name:* Last Name Required Prefix: Prefix is not valid ---MrMrsMsDrAssoc ProfProfHon Gender: Gender is not valid -------MaleFemale Date of Birth: Date of Birth is not valid Organisation Name: Organisation Name is not valid Home Phone: Home Phone is not valid Work Phone: Work Phone is not valid Mobile Phone: Mobile Phone is not valid Fax: Fax is not valid Occupation: Occupation is not valid Seeking work?: Seeking work? is not valid -------YesNo Available work days: Available work days is not valid Current employer: Current employer is not valid What environment do you work in?: What environment do you work in? is not valid Hospital Dermatology Clinic Private Dermatology Practice Cosmetic Dermatology Clinician Other Would you be interested in being on the state event committee or a state representative?: Would you be interested in being on the state event committee or a state representative? is not valid Yes No Possibly I agree to be bound by the Terms and Conditions of the Association: I agree to be bound by the Terms and Conditions of the Association is not valid Yes Are you eligible to work in Australia - please confirm your status (You may be required to provide proof of your eligibilty): Are you eligible to work in Australia - please confirm your status (You may be required to provide proof of your eligibilty) is not valid ------Australian/NZ CitizenStudent VisaDependent VisaOther Further information: Further information is not valid Referred by: Referred by is not valid Email:* Invalid Email No val Please fix the errors above
