Extending information for rural health professionals

ACRRM members, or RRMEO subscribers, can access these modules by enrolling via the ACRRM website here.

For others who wish to apply for free access (sponsored via Cancer Australia) please complete the following form.

Personal details

* = required information

Select a choice

* First name

* Last name

* Email

Date of birth

Country of birth

Gender

Male
Female
Other

Preferred username

We will endeavour to use your preferred username if it meets our system requirements and is available. You may use these characters: a-z A-Z 0-9

* Address 1

Address 2

Address 3

* City

* State

* Postcode

* Work phone

Home phone

Fax

Mobile phone

Professional details

* AHPRA number

Company / Organisation / Practice name

Provider No (First 6 digits only)

PDP / QA CPD Number

Position Held

Qualifications

Educational Program Details

* Occupational Category

Student
Pre-Vocational (eg Junior Doctor)
Registrar
General practitioner
Specialist
Nurse
Staff
Other

Privacy Policy (please read the disclaimer and tick the boxes if you agree to these terms)

I acknowledge that:

The personal information concerning me provided to the Australian College of Rural and Remote Medicine (the "College") contained in this application or otherwise obtained or provided to the College in the module of the program you have selected, is provided, and may be held, used and disclosed by the College for the purpose of processing my application for participation in the selected Program, administering, maintaining or notifying my participation in or otherwise for the purposes of the selected Program and communicating with me for any purpose.
The personal information provided in this proposal is collected and will be held by the College whose address is GPO Box 2507, Brisbane, Qld, 4001, Australia.
The personal information provided for the purpose of participating in this Program will be shared with the subscribing institution for the purpose of reporting and evaluation only.
If I fail to provide any information requested in this application the College may be unable to process or accept this application and/or permit my participation in the Program.
I have the right under the Privacy Act 1993 to obtain access to and correction of any personal information held by the College for the purpose of my participation in the Program concerning me.

I have read and acknowledge the above.

I authorise the College to obtain at any time from any person or entity, (including but not limited to those persons nominated in this application), any information the College may require to:

Process and/or accept this application.
To verify and confirm any information or details I may provide to the College in the module of the Program.
To service and maintain my participation in the Program and to enable the College to properly perform all its functions and powers in respect of participation in the Program.
I authorise any such person to release to the College any personal information that person holds concerning me.

I have read and understand the above

Once your application is submitted it will take 1 to 2 business days to process. An email will be forwarded to you to confirm when access has been granted.