Medical Indemnity Protection Society Limited

Online Student Membership Form

If you're a medical undergraduate, you’re eligible for FREE MIPS student membership!

It's so easy to apply!

First read our Student Policy Wording... Student Policy (316 KB) ...and then fill out and submit the form below.

Membership Declaration

I wish to apply for membership of the Medical Indemnity Protection Society Limited ACN 007 067 281 (MIPS) upon the terms of the Constitution, from time to time in force, a copy of which is available here.

I understand that:

the personal information on this form is required by MIPS and MIPS Insurance for their business operations including the provision of services to members, and
MIPS may engage lawyers, brokers, insurers, information technology and management service providers, and that this information will be available to and will be used by them only for the business operations of MIPS.

ONLINE APPLICATION

Personal Details

*Denotes Mandatory Field

Title:
First Name:*
Surname:*
Gender:*
Date of Birth (DD/MM/YY):*
Type of Membership:*

ONLY complete this field if you are a Medical Protection Society (MPS) member AND an Overseas Medical student.

MPS Membership Number:

Personal Address Details

Street Address:*
Suburb/City:*
Postcode:*
State:*
Country:

Contact Details

STD area code:
Home phone:
Fax:
Mobile:
E-mail: *
University:*
Expected year of Graduation:*
Please enter any message you wish to send here:

	Student Application
	Elective Application
	Events
	Competitions

Medical Indemnity Protection Society Ltd (MIPS) is an Australian Financial Services Licensee (AFS Lic. 301912). MIPS Insurance Pty Ltd (MIPS Insurance) is a wholly owned subsidiary of MIPS and holds an authority issued by APRA to conduct general Insurance business and is an Australian Financial Services Licensee (AFS Lic. 247301). MIPS has a binding authority from MIPS Insurance to issue the MIPS Insurance medical indemnity policy. Any financial product advice is of a general nature and not personal or specific.