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• your principal place of residence, if you are not practising the profession or are not practising the profession predominantly at one address.

Principal place of practice cannot be a PO Box.

City/Suburb/Town*

The information items marked with an asterisk (*) will appear on the public register.

State/Territory* (e.g. VIC, ACT)

Postcode*

Site/Building and/or position/department (if applicable)

Principal place of practice for a registered health practitioner is:

  • the address at which you predominantly practise the profession, or

Address (e.g. 123 JAMES AVENUE; or UNIT 1A, 30 JAMES STREET)

ASGR-40

9. Is the address of your principal place of practice the same as your residential address?

YES

NO

*ASGR-40*

Provide your Australian principal place of practice below

10. What is your mailing address?

My residential address

Your mailing address is used for postal correspondence.

My principal place of practice

Other (Provide your mailing address below)

Site/Building and/or position/department (if applicable)

Address/PO Box (e.g. 123 JAMES AVENUE; or UNIT 1A, 30 JAMES STREET; or PO BOX 1234)

City/Suburb/Town

State or territory (e.g. VIC, ACT)/International province

Postcode/ZIP

Country (if other than Australia)

11. What are your contact details?

Provide your current contact details below – place an Business hours

next to your preferred contact phone number. Mobile

After hours

Email

Effective from: 9 September 2014

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