Please complete the following information to access your Country SA Corporate Membership Portal
Full Name
*
Email
*
Job Title
*
Practice / Organisation Name
*
Sector
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General Practice
ACCHO or AMS
Aged Care
Allied Health
Community
Pharmacy
Region/Local Health Network
*
Barossa Hills Fleurieu Local Health Network
Eyre and Far North Local Health Network
Flinders and Upper North Local Health Network
Limestone Coast Local Health Network
Riverland Mallee Coorong Local Health Network
Yorke and Northern Local Health Network
City
*
State
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SA
NSW
QLD
VIC
TAS
WA
NT
ACT
Postal Code
*
Phone
*
Confirmation
I confirm that I am currently working within a practice, service, or organisation located within the Country SA PHN region.
Consent
I consent to CDM Plus sharing my information with Country SA PHN for program monitoring, evaluation, and engagement purposes.
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