Professional Membership
Personal Information
First Name
Last Name
Date of Birth
Gender
Male
Female
Address
State
Select State
New South Wales
Queensland
South Australia
Tasmania
Victoria
Western Australia
Australian Capital Territory
Northern Territory
City
Postcode
Phone
Fax
Mobile
Your Email
Your Password
Confirm Password
Profile Image
Signature
Current Passport Photo
Current Visa status
(If holding Overseas Passport)
Educational Qualification
Select Qualification
Australian Qualified
Overseas Qualified
Advanced diploma of Ayurveda (HLT62615)
Institute
Select Institution
Australian Institute Of Higher and further Education PTY LTD
Ayurveda College PTY LTD and further Education PTY LTD
Australasian Institute Of Ayurvedic Studies PTY LTD
Nirvana Holdings PTY LTD. T/S Health Institute Australia
Equals International (AUST) PTY LTD
The Collective Wellness Institute
Qualification
Completion Date
BAMS(bachelor of Ayurvedic medicine and surgery)/Any post graduation qualification
Vetassess cert, BAMS Marks Sheet/transcript, Registration cert, and others certificate
>
Institute/Place
Qualification
Completion Date
X
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Clinic
Information
Clinic Name
Clinic Email
Clinic Address
Clinic State
Select State
New South Wales
Queensland
South Australia
Tasmania
Victoria
Western Australia
Australian Capital Territory
Northern Territory
Clinic City
Clinic Postcode
Clinic Phone
Clinic Fax
Clinic Mobile
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References
First Reference Name
First Reference Contact
Second Reference Name
Second Reference Contact
Membership Fees
Application
A$40.00 (Non-refundable)
Annaual Professional Membership
A$200.00
AAA Documents
A$40.00
Total
A$280.00
Bank Details
Bank of South Australia, BSB: 105 008, Account No: 065009540
Note: Please send your cheque or money order made out to:
The Treasurer, Australasian Association of Ayurveda Inc., 23 Albion Street, Harris Park 2150 NSW
I agree to the
terms and conditions
I, hereby apply for Professional Membership with the Australasian Association of Ayurveda Inc, (A.A.A.), and declare that all the information and documents provided with this application are current and correct. I declare that I have no prior criminal conviction in Australia or overseas.
I have not been refused, disciplined or rejected by any other Professional organization. (If yes, please give reason/s and brief description for AAA to make further enquiries, you may use a separate piece of paper). I am aware that giving wrong or willfully incorrect information will result in cancellation of my membership, and may be prosecuted. I also undertake to abide with the terms and conditions of the Professional Code of Conduct and Ethics of the AAA.
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