Member Application Form – AusPATH Main Website

Select *Please confirm the level of membership you are applying for.

Username (DO NOT USE AN EMAIL ADDRESS) *You will use this name to log in

Email *

Password *

Phone *

Title *

My title:

First name *

Last name *

My pronouns are: *

Other pronoun:

Is your gender different to what was presumed for you at birth? I.e. are you trans? *

Are you experiencing financial hardship and seeking the trans membership tier? *

YesNoNo further rationale will be sought and your answer is kept confidential.

Please tell us how you are experiencing hardship. *

Mailing address

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Country

Are you currently studying fulltime?

What are you studying and where?

What is your student email?

Professional discipline *

Professional Qualifications (abbreviations only please) *

Other professional discipline

Professional Accreditation Registration number *

Google Scholar, Scopus, ORCID or other personal research publications URL

Practice data disclaimer

Your professional information will be publicly available on our website. If you are not a service provider, or you do not want your profile to be published in the providers listing, please leave ALL professional information details blank.

You may also opt out of the providers listing at any time.

Practice name

Practice website

Practice email

Practice phone

Practice fax

Practice address

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

1. Please explain your interest in joining AusPATH. *

2. What is your experience in caring for the health, wellbeing, and affirmation needs of trans (binary and non-binary) people? *

3. Can you explain the model/s of care you use in the delivery of gender affirming care to trans (binary and non-binary) people? *

Recurring Subscription *

I acknowledge that by joining AusPATH, I understand that this is a recurring subscription until I cancel my membership. My credit card details are securely stored on Stripe, an external payment gateway. I also acknowledge that AusPATH does not keep my credit card details on their website.

Terms and Conditions *

I agree to AusPATH's terms & conditions