CPD Homes Application Form

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?

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.

*Security Check