Online Membership Application Form Generator

EMSPA(NSW) Inc. Rules and By-laws

EMSPA(NSW) Inc. recommends reading the Rules prior to submittting an application.

Membership Information

One time Application Fee: $5
Membership Fees: $15 per fortnight

Instructions

Fill out the Online EMSPA (NSW) Inc. Online Membership Application Form (below)
Print the successfully generated EMSPA (NSW) Inc. Membership Application Form (check details)
Print and complete the EMSPA (NSW) Inc. Direct Debit Form (available here)
Sign your Membership Application Form and where applicable have your Nominee's sign

Make your One time Application Fee via Cheque, Money Order or Direct Deposit of $5 to:

Institution:	Westpac
Account Name:	Emergency Medical Service Protection Assoc (NSW)
BSB:	032837
Account Number:	228345

PLEASE USE YOUR BUNDY AS REFERENCE SO WE CAN TRACK YOUR PAYMENT

Send the EMSPA (NSW) Inc. Membership Application Form WITH YOUR COMPLETED DIRECT DEBIT FORM (DO NOT SEND TO ASNSW PAY OFFICE) AND IF APPLICABLE CHEQUE OR MONEY ORDER to:

EMSPA(NSW) Inc.
PO Box 4035
Warrimoo, NSW 2774

If you are having trouble with the online application form or would like to give a hard copy to a friend or co-worker, please use our Hard (Paper) Copy Member Application Pack, available here.

DO NOT SEND YOUR DIRECT DEBIT FORM TO ASNSW PAY OFFICE as your full application must be reviewed and approved by EMSPA before membership is granted - successful applicants will have their completed Direct Debit form processed.

EMSPA (NSW) Inc. Membership Nominations
If there are no EMSPA (NSW) Inc. members in your area, please leave the “Nominator” section of the application form blank. The committee will sign as nominators. After the Association has members in the area, all applicants will be required to source their own nominations from EMSPA (NSW) Inc. members.

Following submission of your application, the EMSPA (NSW) Inc. Committee will review your application and if accepted you will receive a New Member Pack in the mail as well as an email with your EMSPA (NSW) Inc. website account details, giving you access to the Members Area and Forum. User details from ParamedicsNSW WILL NOT work at EMSPA (NSW) Inc.

Application for Membership

Please ensure ALL details are completed. You MUST be an employee of the Ambulance Service of New South Wales to join EMSPA (NSW) Inc.

Personal Details

Surname:

First Name:

Address:

Suburb:

State:

Post Code:

Date of Birth:

(DDMMYY)

Home Phone:

Mobile:

Primary Email:

Primary email, will be used as first contact email only (preferably not ASNSW email)

ASNSW Email:

Optional, or if no other email exists

Employment Details

Division:

(eg. Western Division)

Sector:

(eg. New England Sector)

Station:

(eg. Barraba)

Position:

Additional Qualifications
(please mention if Part Time) :

Registered Nurse	Special Operations
SCAT	Medical Retrieval Unit
HIRT	Helicopter Ops
Rescue
Other (please specify):

BUNDY: