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Member Details

First name*
Last name
Username*
Email*
New Password*
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Personal Details

Address*
Address 2
Town/Suburb*
Postcode*
State*
Phone (home)
Phone (work)

Professional Details

Registration Number*

Nurses and Midwifery Board registration number

Registered Surname*

Surname on Registration

Employer*

Position*

Qualification*

If required, please specify below.

Other Qualification

CAFH Qualification*

Child and Family Health related qualification

Institution*

Date Obtained*

Year

Month

Days

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Declaration

I declare that I hold current registration according to the information detailed above and I accept to be bound by the Regulations of the Child and Family Health Nurses Association (NSW) Inc. I understand that all information sought by the Association or any Committee of the Association, in relation to my application shall for all purposes remain confidential.

I have read and agree.