QUTSPA Membership Registration Form
Free QUTSPA membership is available for all currently enrolled pharmacy students at QUT!

Thank you to The Pharmacy Guild of Australia for supporting free QUTSPA student memberships.
Title *
First Name *
Last Name *
Gender *
Date of Birth  *
MM
/
DD
/
YYYY
Contact Number *
Personal Email *
Home State *
Post Code (Home, if an international student type "INT") *
QUT Student Number
Enrolment Type *
Expected year of graduation (final year of degree) *
Domestic or international student? *
Are you a current PSA member? *
If currently PSA member please provide your membership number (otherwise leave blank) *
I consent to the Pharmaceutical
Society of Australia collecting and using my
information for marketing purposes in
accordance with the PSA Privacy Policy.

https://www.psa.org.au/about/privacy/
 *
Do you wish to become a PDL member and do you consent to all terms and conditions as outlined?

https://pdl.org.au/privacy-policy/
 *
In the last 5 years, have you ever held a Public, Products, or Professional Liability insurance policy and / or been convicted of a criminal offence (other than a minor traffic infringement)?
 *
Do you consent to this data being shared with the Pharmacy Guild of Australia for the purposes of becoming a PGA student member?

 *
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