AUSTRALASIAN SOCIETY OF CAREER MEDICAL OFFICERS
  2008 Membership Application Form
   www. ascmo.org.au      

   Please print this page and forward your completed application, with payment to:

Section A
ASCMO Membership:
Renewal/Joining for full year
Jan - Dec 2008:
    CMO:               $120.00        
    Registrars:          $ 60.00       
    RMO 1 & 2:      $ 60.00       
    Interns:                   Free        
    Students:                Free        
OR Joining ASCMO during 2008:
(Where Mths = months remaining to Jan 2009)

CMOs:                  mths @ $12/mth =
($12 for each mth remaining in 2008)

Regs/RMOs:        mths @ $ 6/mth =
($6 for each month remaining in 2008)
Section B
2008 Subscription to CPDP
(Continuing Professional Development Program): (click here for more details)
This program is only available to financial members of ASCMO. Renewal and joining fees are the same for CMOs/Regs/RMOs
    Windows 95/98/NT: Annual Fee = $55.00   
    Manual version: Annual Fee = $110.00   
    (Macintosh version has been discontinued)
If you have any queries about this programme please contact: 		Name:  __________________________________

Mailing Address:   ______________________

  ________________________________________


Ph:    Home:   ____________________________

    Work:    ____________________________

    Fax:      ____________________________

    E-mail:  ____________________________

I agree to be bound by the rules of the
society while I am a member.

Signature:         ________________________

Date:                  ________________________


PAYMENT:

Please calculate total for A + B = . . . . .
making cheques payable to: Australasian Society of Career Medical Officers and mail to:
    ASCMO Administration
    378 Forest Road
    Bexley
    NSW 2207
All enquiries to: officemanager@ascmo.org.au

Occupational Survey

One of the major tools at our disposal in the struggle to have the CMO role recognised and respected is information. We need to know who we are, where we are, what we're doing and how we're being paid. In order to keep our information up to date, please complete the occupational survey again. We know that you are a fairly mobile lot!

We recognise the variety of employment choices for CMO's. Please add any information you think relevant, and feel free to tick more than one box per question. Results will be published in the CMO bulletin.

All personal details are removed from survey forms before analysis. Data is used for information only within ASCMO and is not made available to any other persons.


Name:  ________________________________

Work Address:   ________________________

 ______________________________________

Area of Interest:  _______________________
     (DD, Psych, Psycho-geri's, Emergency, etc)

Type of Work:

 Medical Student            Intern
 RMO 1st yr                   RMO 2nd yr
 Primarily Clinical            Research    
 Primarily Non-Clinical    Administrative

Year of Graduation: _________________

Qualifications: (Please Include post-grad diplomas,
fellowships, and degrees outside medicine)

_______________

__________________

I am also a member of:
 ASMOF       AMA     
 HSU          Other _______

Do you have Vocational Registration: 
           Yes                 No

 Hours of Work
 Fulltime                         Part-time  
 Part-time (several locations)   Locum

Location of Work: 
 City                               Suburban
 Regional                        Remote

 Teaching Hospital         Community Hospital
 District/Base Hospital    Private Hospital
 Community Health        Medical Centre
 Dept of Health               General Practice
 Government Instrumentality
 Other   _______________________________

Basis of Payment:
 CMO's award                RMO's award
 Sessional                       Contract
 Salaried Position           Fee for service
 Other   ________________________________

Membership of Professional Associations
(eg RMO's Ass'n)

       _______________________________________
Which Area of CMO practice are you currently engaged ? (you may tick more than one box)
Emergency,           Psychiatry,          Police Forensic,
Developmental Disability,          Community Health,          Obsetrics and Gynaecology,
Paediatrics,          Palliative Care,          General Hospital Duties,
Child Protection,          Drug & Alcohol,          Sexual Assualt,
Sexual Health,          Women's Health,          Aboriginal Health,
Medical Administration
Other (Please specify) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Please use the back of this form if you wish to make any comment, or include additional information.

Thank You For Your Time

Return to ASCMO Home Page

updated 14th Jan 2008

this information is intended for the use of medical professionals only
page maintained by David Brock on behalf of ASCMO,

email: davbrock@ozemail.com.au