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Psychiatry Interest Forum application – students

Form for medical students to apply for membership of the Psychiatry Interest Forum.
Please note, you must be enrolled in an undergraduate or graduate medical course approved by an Australian or New Zealand medical school to apply.

Not a medical student? Use the Psychiatry Interest Forum application form for medical practitioners instead.

Changed your details? No need to reapply, login and update your details online.
 

About the Psychiatry Interest Forum

Declaration

By submitting this application, I acknowledge, agree and declare that:

1. The information I have provided in this application form is current, true and correct;

2. I consent to the RANZCP collecting, storing and using my personal information for the purpose of administering my participation and providing services to me as well as (unless I have 'opted out' by contacting the Membership Services Department) sending me advertising information by itself or its related committees.

3. I am enrolled in an undergraduate or graduate medical course approved by an Australian or New Zealand medical school.

4. I consent to the RANZCP contacting my educational institution to verify my enrolment.

Personal details


Title*

First name*

Surname*

Gender

Are you of Aboriginal, Torres Strait Islander or Māori origin?

Contact details

Address line 1*
(maximum 40 characters)

Address line 2
(maximum 40 characters)

Suburb/town*

State
(leave empty if outside Australia)

Postcode
(leave empty if outside Australia or New Zealand)


Country*

Mobile phone number*

Student email address*

Please retype student email address*

Your student email address is a required field to show that you meet the student member eligibility criteria. Confirmation that we have received your PIF application will be emailed to this address.

Personal email address*

Please retype personal email address*

Preferred email address*


Study details

Currently enrolled at*

Currently undertaking the following qualification*

Year of study*

Year of commencement*

Expected year of completion*

Other information

Which areas of psychiatry practice are you interested in?
(choose any that apply)











 
Other:
 
What prompted you to apply to join the forum?
(choose any that apply)



 
Other:
 
How did you hear about the forum?
(choose any that apply)





 
Other: