Mailing List Registration Form

Stay in Contact – register your details for our mailing list

One of the primary objectives of NICM is to facilitate communication, exchange of ideas and collaboration between people and organisations with an interest in complementary medicine. In order to do this and to enable you to receive our newsletter and any other relevant information we need your contact details.

If you have not already emailed us your details, please complete the below registration form or fax to 02 4620 3722. Telephone enquiries can be made on 02 4620 3705.

Title

Full Name

Institution or Business

Position

Address

Postcode

State

Email Address

Work Number

Mobile Number

Area of Interest/Research/Practice:

I am happy for NICM researchers to use my personal information on this form and contact me about participating in relevant research in the future.

Personal information collected by NICM is treated as confidential and is protected by the New South Wales Privacy and Personal Information Act. NICM will not disclose personal information concerning you, including your email address, to parties outside NICM except in accordance with the Act.