ANZMTG Membership Application
Please complete the following form and nominate two referees from the list below to support your application.
Your membership request will be emailed to these referees and the ANZMTG administrator, and you will be advised when your application is successful. Membership is free and does not need to be renewed annually.
ANZMTG respects your privacy and will ensure the confidentiality of all personal information. We invite your feedback and should you have any enquiries please do not hesitate to contact us by emailing .
Applicant details
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Membership
ANZMTG Membership benefits include:
- Access to a professional network for melanoma research, including clinicians, nursing staff, industry affiliates and patient/consumer representatives
- Support for the development of investigator-initiated studies
- Access to grant opportunities
- ANZMTG quarterly newsletter and the latest sector news updates
Full ANZMTG Membership is open to Australian and New Zealand researchers and health professionals with an interest in melanoma clinical trials. Other International collaboration is also welcomed.
Consumers, including melanoma patients and carers, their family and friends, are invited to be Associate ANZMTG Members and to engage in ANZMTG research activities. Associate Membership is also open to industry representatives.
If you would like to apply for membership and cannot recognise any of the listed referees, please contact the ANZMTG office directly.
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| Title: |
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| First Name *: Required |
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| Last Name *: Required |
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| Institution: |
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| Department: |
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| Address: |
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| State *: Required |
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| Postcode *: Required |
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| Country *: Required |
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| Do you live in a rural / remote area? *: Required |
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| Primary Email *: RequiredInvalid email address |
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| Secondary Email: Invalid email address |
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| Phone: Phone number must contain only numbers |
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| Mobile: Mobile number must contain only numbers |
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| Fax: Fax number must contain only numbers |
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| How would you broadly describe your position category? |
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| How would you broadly describe your professional discipline? |
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Membership details
Full Membership - open to melanoma researchers and health professionals.
Associate Membership - open to consumers (including melanoma patients and carers, and their family and friends) and industry representatives.
International Membership - open to melanoma researchers and health professionals from outside Australia and New Zealand.
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| Membership Type *: Required |
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| If you are applying for associate membership as a consumer, do you give permission for ANZMTG to contact you regarding consumer activities (e.g. the development and review of clinical trial protocols)? |
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| If you are applying for full or international membership, do you give permission for ANZMTG to contact you regarding industry activities? |
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| Referee One *: Required |
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| Referee Two *: Required |
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Referees must be different
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