Individual Membership Application Please enable JavaScript in your browser to complete this form.Name *FirstLastGender *Email *Date of Birth (DD/MM/YYYY) *Work/Residential Address *Mobile Number *Language(s)Which membership would you like to join? *One Year - $60Two Year - $100Five Year Advanced Member - $240Ten Year Honorary Member - $450Professional Modality *Chinese Herbal Medicine PractitionerAcupuncturistChinese Herbal DispenserTCM AcademicTCM StudentTCM AssociateI confirm the information provided is true and accurate *YesNoBy ticking the boxes below, *I consent to become an individual member of the Chinese Medicine Industry Council of Australia Ltd (CMIC) and agree to comply with the CMIC’s policy and rules.I consent that CMIC office will contact me via email and I will be added to the CMIC mailing list for updates on events and activities.Submit
