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CPD Homes Application Form

https://www.acsep.org.au/page/about/fees

Preferred Contact Details

Title

*First Name

*Surname

Address

*Postcode

Country

Telephone

*Mobile

*Email

Please provide details of your connection to, or on-going interest in, the field of Sport and Exercise Medicine:

Is there any other information you would like the CPD Committee to consider when assessing your application?

Please list any specialist registrations you hold with AHPRA /MCNZ

ACSEP CPD Program participants are required to hold current registration with either AHPRA or MCNZ, please confirm your registration below as applicable:

I confirm that I hold current registration to practice as a medical practitioner with AHPRA

I confirm that I hold current registration as a practitioner with MCNZ

*Curriculum Vitae

Your application will be reviewed by the ACSEP CPD Committee and you will receive an
outcome via email.

*I confirm I have reviewed the ACSEP CPD Homes fees page at: https://www.acsep.org.au/page/about/the-college/fees
You can read about it here

Yes/Accept

*Security Check