HCP Membership

IDFA Membership Application Form - Healthcare Professional

To be an IDFA HCP member you must be a resident of Australia and are actively involved in clinical practice, immunopathology, teaching or research relating to clinical immunology or allied health services in Australia.

Please note:

IDFA Healthcare Professional membership is based on individual membership applications, not group applications.
IDFA processes membership applications within 4 business days. If we require further information to process your application, we will be in contact.

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Your Personal Details
Full Name:*
First Name Surname
Preferred Name:
Title (Miss/Ms, Mrs, Mr, Dr, Prof, etc):
Date of Birth:*
DD slash MM slash YYYY
Sex:*
- Female
- Male
- Prefer not to say
First Nations:*
- Aboriginal
- Torres Strait Islander
- Prefer not to say
- Neither
Occupation Title:*
Healthcare Professional Field:*
- Immunologist
- GP
- Paediatrician
- Nurse
- Researcher
- Clinical Nurse Consultant
- Respiratory physician
- Gastroenterologist
- Rheumatologists
- Haematologist
- Neurologist
- Psychologist
- Allergist
- Oncologist
- Other (Please list)
Please List Professional Field:*
Your Contact Details
Email:*
Mobile Phone:*
Alternative Contact Number:
Main Address:*
Address Line 1 Address Line 2 Suburb State/Territory Postcode Country
Postal Address:
Select if different to above
Postal Address:*
Postal Address Line 1 Postal Address Line 2 Postal Suburb Postal State/Territory Postal Postcode Postal Country
Organisation Details
Organisation Type:*
- Hospital
- Private Practice
- Other (Other Type of Organisation)
Hospital Name:*
Hospital Email:*
Hospital Contact Number:*
Hospital Website:
Hospital Socials:
Hospital Address:*
Address Line 1 Address Line 2 Suburb State/Territory Postcode Country
Hospital Postal Address:
Select if different to above
Hospital Postal Address:*
Postal Address Line 1 Postal Address Line 2 Postal Suburb Postal State/Territory Postal Postcode Postal Country
Practice Name:*
Practice Email:*
Practice Contact Number:*
Practice Website:
Practice Socials:
Practice Address:*
Address Line 1 Address Line 2 Suburb State/Territory Postcode Country
Practice Postal Address:
Select if different to above
Practice Postal Address:*
Postal Address Line 1 Postal Address Line 2 Postal Suburb Postal State/Territory Postal Postcode Postal Country
Organisation Name:*
Organisation Email:*
Organisation Contact Number:*
Organisation Website:
Organisation Socials:
Organisation Address:*
Address Line 1 Address Line 2 Suburb State/Territory Postcode Country
Organisation Postal Address:
Select if different to above
Organisation Postal Address:*
Postal Address Line 1 Postal Address Line 2 Postal Suburb Postal State/Territory Postal Postcode Postal Country
General Information
How did you find us?*
- Internet Search
- Event (Please list)
- IDFA Member
- Networking (Please list)
- IDFA Collateral
- Other Healthcare Professional
- Social Media
- Word of Mouth
Please list the event where you found us:
Please list the networking occasion where you found us:
Why would you like to join IDFA?*
Consent to Receive Marketing Communications
I consent to receive marketing communications from Immune Deficiencies Foundation of Australia.
By providing your contact information and selecting the consent box above, you agree to receive marketing communications from the Immune Deficiencies Foundation of Australia via email, SMS, phone, or other digital channels. These communications may include news, offers, promotions, and updates about our products and services.

You may withdraw your consent at any time by clicking the “unsubscribe” link in our emails or by contacting us via email at info@idfa.org.au.
Consent to Privacy Policy*
I agree and understand to the privacy statement.
Your personal information will be handled in accordance with our Privacy Policy.
Would you be interested in sharing your story with the IDFA Community?*
- Yes, I would like to contribute a short clip of me saying the IDFA motto of "I don't feel alone"
- Yes, I would like to be contacted to share my full story.
- No, I do not want to share a clip or my story.
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HCP Membership

IDFA Membership Application Form - Healthcare Professional

Your Personal Details

Your Contact Details

Organisation Details

General Information