Online Membership Application Form

Thank you for your membership

Your membership begins when you join the association. Annual fees of $100 will be due on the 30^th June. We will adjust fees on a pro-rata basis at $10 monthly to cover our administrative costs (please do not adjust fees yourself).

On receiving your payment, we will send you a receipt, an ACSA membership card and number and the ACSA Clinical Supervisor Database application form. Please see the ACSA Constitution.

Payment details

Account Name: Australian Clinical Supervision Association Inc.

BSB Number: 633000

Account Number: 153065537

Customer Reference Number (CRN) in banking details: Enter your name for CRN.

Bank: Bendigo Bank.

membership@clinicalsupervision.org.au

Processing times

Please allow up to 10 working days for ACSA to process your application. If you have not heard back from us then, please remake contact. Sometimes, we are unable to identify you from your banking details so we are unable to contact you. In the meantime, you are welcome to use any of our online resources and attend any of our Local Member Meetings.

Welcome to the Australian Clinical Supervision Association

The following application records your details with ACSA, which is a legal requirement for membership. To pay your membership fees, please go to your bank account and use the above details to make your payment.

Membership Application Form

* indicates required field

First Name:*

Last Name:*

Your title:*

Ms Mr

Email:*

Address (include state and postcode):*

Phone contact number:

What best describes your professional background (not your title):*

I understand that ACSA will use my name and email address to contact me on ACSA news.*

Yes No

Would you like your name and email to be forwarded to the convenor of ACSA Local Member Meetings (LMMs), where they occur?*

Yes No

Would you like to be included in the national database of available clinical supervisors? If yes, download the Database Information Form after you register*

Yes No

Have you completed training as a clinical supervisor?*

Yes No

Have you made your payment? (Please note that we will not process your application until your payment has shown up in our bank account).*

Yes No

Have your added your name as the Customer Reference Number (CRN) in your bank payment? (This is important as we cannot process your application without it).*

Yes No

Date

CAPTCHA Code:*

Please note

ACSA will not process your application further if you tick that you have not made a payment at time of applying for membership. We’re not sure why you would apply for membership, yet not pay our fees, but unfortunately, we neither have the time nor will to persuade you otherwise. We hope you understand.