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Contact Information*
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Private Address
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Current Employment*
Type of employment
(students indicate paid employment) full time part time
Occupation*
Employer*
Present position*
Qualifications and Experience*
Main interests in the drug and alcohol field*
Principle activities in the drug and alcohol field*
Research interests in the drug and alcohol field*
Other professional affiliations*
Nomination*
Applications must be supported by a current APSAD member – please contact the office if you require assistance with finding a nominator.
Nominated by*
Please note that a brief Curriculum Vitae and list of publications may be requested prior to consideration of your application.
For Institutional Membership Applications Only
Size of Service Area
Number of clients serviced by your institution
Main source of funding (CIRCLE ONE) GOVERNMENT NON-GOVERNMENT
Further funding details:
Number of staff
Number of professional staff
Are any of your staff current APSAD members? (CIRCLE ONE) yes no How many?
Please tell us why you wish to apply for institutional APSAD membership*

Fields marked with an asterisk (*) are required.

Personal Details*
Surname*
First name(s)*
Email*
Password*
Verify Password*
Title* Miss Ms Mr Dr Prof Other
Contact Information*
Use as general contact details work home
Work Address*
State*
Postcode*
Country (if not Australia)
Telephone*

(w)

(m)
Fax
Private Address
State
Postcode
Country (if not Australia)
Telephone

(w)

(m)
Fax
Current Employment*
Type of employment
(students indicate paid employment) full time part time
Occupation*
Employer*
Present position*
For current students only
Type of candidature full time part time N/A

Degree enrolled*

Institution*

Expected year of completion*

Qualifications and Experience*
Please indicate each degree/ diploma, institution and year conferred*
1. Degree/ Diploma
Institution
Year conferred
2. Degree/ Diploma
Institution
Year conferred
3. Degree/ Diploma
Institution
Year conferred
Main interests in the drug and alcohol field*
Principle activities in the drug and alcohol field*
Research interests in the drug and alcohol field*
Other professional affiliations*
Nomination*
Applications must be supported by a current APSAD member – please contact the office if you require assistance with finding a nominator.
Nominated by*
Please note that a brief Curriculum Vitae and list of publications may be requested prior to consideration of your application.

Fields marked with an asterisk (*) are required.

Personal Details*
Surname*
First name(s)*
Email*
Password*
Verify Password*
Title* Miss Ms Mr Dr Prof Other
Contact Information*
Use as general contact details work home
Work Address*
State*
Postcode*
Country (if not Australia)
Telephone*

(w)

(m)
Fax
Private Address
State
Postcode
Country (if not Australia)
Telephone

(w)

(m)
Fax
Current Employment*
Type of employment
(students indicate paid employment) full time part time
Occupation*
Employer*
Present position*
For current students only
Type of candidature full time part time
Degree enrolled*
Institution*
Expected year of completion*
Qualifications and Experience*
Please indicate each degree/ diploma, institution and year conferred*
1. Degree/ Diploma
Institution
Year conferred
2. Degree/ Diploma
Institution
Year conferred
3. Degree/ Diploma
Institution
Year conferred
Main interests in the drug and alcohol field*
Principle activities in the drug and alcohol field*
Research interests in the drug and alcohol field*
Other professional affiliations*
Nomination*
Applications must be supported by a current APSAD member – please contact the office if you require assistance with finding a nominator.
Nominated by*
Please note that a brief Curriculum Vitae and list of publications may be requested prior to consideration of your application.
This is to confirm I earn less than $50,000 per year

Fields marked with an asterisk (*) are required.

Personal Details*
Surname*
First name(s)*
Email*
Password*
Verify Password*
Title* Ms Mrs Mr Dr Assoc. Prof Other
Contact Information*
Use as general contact details work home
Work Address*
State*
Postcode*
Country (if not Australia)
Telephone*

(w)

(m)
Fax
Private Address
State
Postcode
Country (if not Australia)
Telephone

(w)

(m)
Fax
Current Employment*
Type of candidature* full time part time
Degree enrolled*
undergraduate postgraduate
Institution*
Length of course*
Year started*
Expected year of completion*
Qualifications and Experience*
Please indicate each degree/ diploma, institution and year conferred*
1. Degree/ Diploma
Institution
Year conferred
2. Degree/ Diploma
Institution
Year conferred
3. Degree/ Diploma
Institution
Year conferred
Current Employment*
Are you employed?*
(Indicate paid employment) yes no
Type of employment* full time part time
Occupation*
Employer*
Present position*
Gross Income*
(not including scholarship/s and grants) < $30,000pa > $30,000pa
Interests and Affiliations*
Main interests in the drug and alcohol field*
Principle activities in the drug and alcohol field
Research interests in the drug and alcohol field*
Other professional affiliations*
Supervisor's Confirmation*
Student Applications must be signed by your course Supervisor.
Supervisor's name*
Supervisor's signature*
Supervisor's contact*
Supervisor's email*
Please note that your supervisor may be contacted to confirm student status.
Copy of Student ID included* yes no

Select the type of membership you are applying for by clicking on the drop down box above.

Membership is for one financial year. Members joining later in the financial year will receive back issues of the Drug and Alcohol Review for that year. Renewal notices are emailed to all members in June.

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