Membership Application

- Mentoring
- Are you or your staff interested in being a mentor to AIDA members? yes no If yes, in what areas are you/your staff able to mentor? (e.g. General Practice, Research)
  - Yes
  - No
- Nominator information
  
  Please note that your nominator MUST be a current Indigenous medical doctor or a current Indigenous medical student member of AIDA.
- Do you have a nominator?*
  - Yes
  - No
- Title*
- First Name*
- Last name*
- What is your relationship with your nominator?*
- Is your nominator aware of this application?*
  - Yes
  - No
- Membership term
  
  All fees are GST inclusive
- Fees
  - Associate – Organisation One year $1000
  - Associate – Organisation – non-for-profit, Aboriginal and Torres Strait Islander, student groups One year $250
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