My RDN

Application for membership of the Rural Doctors Network Ltd

Incorporated under the Corporations Law sub-section 121(1)
ACN 081 388 810 ABN 52 081 388 810

Please complete the following form, or download the hard copy and send or fax it back to:

RDN Board Secretariat
PO Box 1111
MASCOT NSW 1460

Phone: 02 83378100
Fax: 02 83378110
Email: membership@nswrdn.com.au

Applicant Details

Title *

First name *

Other names

Surname *

Occupation

Address line1

Address line2

Suburb *

State

Postcode

Country *

Phone

Fax

Email *

Member type *

* I hereby apply to become a Primary Member of the above mentioned incorporated Company. In the event of my admission as a Primary or Associate Member, I agree to be bound by the rules of the Company.

I would like to receive additional information about RDN activities including the Electronic Monday Message