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Neurodevelopmental and Behavioural Paediatric Society of Australasia

NBPSA Membership Application

Membership type

Required

Personal details

Name

Required
Title
First name
Last name
Preferred first name
(if different from First name above)

Identity

Gender
I identify as:

Qualifications

Required
For each qualification, select and click Add:
If you have other qualifications that aren't in our list, please enter them here:

Special interests

For each interest, select and click Add:
If you have other interests that aren't in our list, please enter them here:

Current employment details

Required

Upload your CV

Required
Click this button and select your CV file on your computer, e.g. a PDF file.

Contact details

Email address

Required
Please specify an email address that you can access and use from anywhere. NBPSA will use this email address for all communications, and you will log in with this email address when your membership is activated.

Address

Required
City
State
Postcode
Country

Phone

Required
Preferred number for NBPSA communications
Alternative numbers:
Mobile
Work
Other

Nomination

Required

Please enter the names of two current NBPSA Members holding Ordinary membership who have agreed to support your application. You can check names of current members who may know you on our public Find a Specialist listing. If you require further assistance please contact us.

Nominator

Seconder

Discourse username

Required

Our NBPSA Discussion forums run on software called Discourse, for which you need a unique username.

The username can be from 3 to 20 characters long and can include:

  • uppercase (A-Z) or lowercase (a-z) letters
  • numbers (0-9)
  • hyphen (-) or underscore (_), but not as the first or last character
  • only one hyphen or underscore between other characters
  • no spaces

A suggested username has been generated below from your name, but you can change it if you wish. Both your real name and your username are displayed in Discourse.

Note: Your username cannot be changed after this step - please choose carefully.

Declaration

Required

I declare that:

  1. I have read and agree to support the aims, purpose and values of the NBPSA and to participate in Society activities to further those aims and objectives;
  2. I have read and agree to abide by the NBPSA Code of Conduct; and,
  3. I agree to abide by the  Constitution of the NBPSA (also available through the Society’s website).