Australian Paediatric Research Network- Sign Up

* First Name

* Surname

* Street Address

* Suburb

* State

* Postcode

Phone Number

* Email

* Gender

Female Male

* Year of Birth

* In what year was your FRACP (or equivalent) awarded?

If equivalent, please specify

* Which do you consider your working hours to be?

Full-Time Part-Time

* Are you currently involved in research?

* Which of the following best describe your practice? (select all that apply)

Academic Post Community Health Centre Private Practice Public Hospital Post

* Which of the following best describes your main practice?

Metropolitan N/A Regional Rural

* What is the postcode of your main practice?

Which of the following best describes your secondary practice?

Metropolitan N/A Regional Rural

What is the postcode of your secondary practice?

* What factors have motivated you to join the APRN? (mark all that apply)

Collaboration with colleagues Improving how I run my practice Learning new clinical skills Learning research skills MyCPD points Other Personal satisfaction from contributing to research Providing a platform to express my research ideas

If other, please specify

Members