Membership Renewal

Please check all details are up to date before submitting the renewal form.
Membership renewal cost is $100.
Please ensure that you make payment to
Australian Association of Equine Podiotherapists.
BSB: 063 628 – Account number: 1015 5408.
Please also ensure that you include your name with the payment.
If you have any difficulty at all completing the form please contact the Association Secretary, Lisa Aguis-Gilibert on eptassociation@gmail.com

By submitting your membership renewal, you are authorising the verification of the information provided on the form as to your qualifications and you declare that the information provided is true and correct as of this day.

You also agree to abide by the rules and regulations of the Association:

You wish to continue as a member of the Association; and
support the purposes of the Association; and
agree to comply with these Rules.

Membership Renewal

Applicant Name *

First

Last

Date of Birth *

Mobile Number

Home Phone Number

Residential Address

Postal Address

Email *

Email

Confirm Email

Diploma of Equine Podiotherapy Status

Student
Qualified

Other Relevant Qualifications

Are you currently working as a trimmer/podiotherapist?

Full Time
Part Time
Case Studies Only
No

Do you intend to work as a trimmer/podiotherapist?

Yes
No

Geographic area of your work

Do you have insurance? (optional)

Yes
No

If yes, what sort of insurance do you have?

Public Liability
Professional Risk
Professional Liability
Income Protection
Other

Do you have any other skills you think may benefit the Australian Association of Equine Podiotherapists?

Message