First Name*
Surname*
Preferred Email*
Other Email
Mobile Phone*
Home Phone
Specialty(s) of interest* --Please Select-- Accidents & Emergency Aero-retrieval Aero-retrival All Fixed Term Specialties All Locum Specialties Anaesthetics Director of Medical Services Emergency General practice Indigenous Health Intensive care Locum Director Locum Registrar Locum Resident (Resident/SHO/PHO) Locum Specialist/Consultant Locum Staff Grade (CMO/MOSS) Medicine - Cardiology Medicine - Dermatology Medicine - Endocrinology Medicine - Gastroenterology Medicine - General Medicine - Geriatrics Medicine - Haematology Medicine - Infectious Diseases Medicine - Internal Medicine - Oncology Medicine - Palliative Care Medicine - Rehabilitation Medicine - Remote Hospital Medicine - Renal Medicine - Respiratory Medicine - Rheumatology Medicine - Sports Medicine Nephrology Neurointerventional Neurology OBSTETRICS & GYNAECOLOGY Ophthalomology Paediatrics - General Paediatrics - Neonatal Pathology - Anatomical Pathology - Chemical Pathology - Clinical Pathology - Cytopathology Pathology - Forensic Pathology - General Pathology - Histopathology Pathology - Neuropathology Psychiatry - Addictions Psychiatry - Child & Adolescent Psychiatry - Child & Youth Psychiatry - Forensic Psychiatry - General Adult Psychiatry - Geriatric Psychiatry - Old Age Radiographer Radiology Registrar (SPR) Resident (SHO) Sexual Health Specialist/Consultant Staff Grade (CMO/MOSS) Surgery - Cardiothoracic Surgery - ENT Surgery - General Surgery - Maxillofacial Surgery - Neurosurgery Surgery - Oncology Surgery - Orthopaedics Surgery - Orthopaedics - Paediatric Surgery - Paediatrics Surgery - Plastic Surgery - Plastics Surgery - Transplant Surgery - Urology Surgery - Vascular
Seniority(s) of interest* --Please Select-- Locum Director Locum General Practitioner Locum Registrar Locum Specialist/Consultant Locum Staff Grade (CMO/MOSS)
What type of AHPRA medical registration do you currently hold?* --Please Select-- General Registration Specialist Registration Eligible for General Registration
What is your Australian residency status?* --Please Select-- Australian Citizen Permanent Resident Temporary/Visa holder with working rights New Zealand Citizen
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