Apply online Membership Application "*" indicates required fields Step 1 of 2 50% Name* MrMr.Mrs.Ms.Prof.Dr.Other Title First Middle Last Date of Birth* DD slash MM slash YYYY Home PhoneMobile Phone*Email* Name of Spouse / Partner Full Name Residential Address* Street Address Suburb State Post Code Is your residential address the same as your postal address?* Yes No Postal Address* Street Address Suburb State Post Code Employment Status Currently retired?YesNoNo, in Transition To RetirementCurrent Employment*NoneAmbulanceOtherPlease specify your current role in your position: Planned Retirement Date: Date you retired: Period of service to Ambulance location(s)* Do you agree to abide by the Rules, Policies & Standards of the Association?* Yes No CAPTCHA Contact Us
