Student Membership Application Form

The First Step...

We invite you to apply for Free Student Membership online by completing the form below, or, you may download the Student Application Form and post into ANTA at your convenience.

Before you begin the Student Membership Application process please ensure you are enrolled in and completing a Course that is Recognised by ANTA. You may also be eligible for Student Membership if you intend continuing onto an ANTA recognised course.

Please note: ANTA does not recognise undergraduate courses delivered substantially by Distance/Online or External modes.

Health Funds do not recognise for provider registration purposes any undergraduate qualifications attained substantially by Distance/Online or External Modes.

Student Application Form

* denotes required field

Personal Information (Kept confidential by ANTA)

Title:	*
First Name:	*
Middle Name:
Surname:	*
Date of Birth:	*
Email:	*
Residential Address
Street Number/Street Name	*
Suburb:	*
State:	*
Postcode:	*
Contact Info
Phone No. Area Code:	*
Phone No:	*	Enter Phone number without space
Mobile:	*	Enter Mobile number without space
Postal Address
Same as Residential:	*
Postal Address:
Postal Suburb:	*
State:
Postcode:
Modalities Studying
Check Modalities Studying:	*	Acupuncture Aromatherapy Ayurvedic Medicine Chinese Herbal Medicine Counselling Homoeopathy Myotherapy Musculoskeletal Therapy Naturopathy Nutrition Oriental Remedial Therapy Remedial Massage Therapy Shiatsu Western Herbal Medicine
Educational Facility
Currently Enrolled at:	*
Student ID Number:	*
Course Qualification:	*
Name of Course:	*	Completing a Recognised Course?
Expected Date of Completion:	*	E.g: 01/02/2008
Note: ANTA (including Health Funds & WorkCover) does not recognise undergraduate courses delivered in total by Distance Education
Disclaimer:		I confirm that the course I am studying or enrolled in is not delivered by distance education
Terms and conditions
The course I am currently enrolled in is not being undertaken "Substantially" by Distance Education. I hereby consent to ANTA making the necessary checks with my Course Provider to confirm that I am currently enrolled as a student. I have not been convicted of a criminal offence in Australia or overseas. I acknowledge that ANTA may, in its absolute discretion, grant or refuse Student Membership without assigning any reason. If accepted as a Student Member of ANTA, I agree to be bound by the rules and regulations established from time to time by ANTA. ANTA reserves the right to cancel Student Membership at anytime without prior notice.
Disclaimer:	I confirm/agree to the terms and conditions above.
Enter code as shown below:*