Type of Membership application

FULL MEMBER: Annual Fee $448.00 (includes GST)
A full member is a healthcare professional providing services for people with or affected by diabetes. A full member has full voting rights, can hold office and apply for recognition as a Credentialled Diabetes Educator and receive all notices and publications and participate in ADEA discussions and networks.

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AUSTRALIAN ASSOCIATE MEMBER: Annual Fee $327.00 (includes GST)
An Australian associate member is a person who has an interest in diabetes education and is an Australian resident. An Australian associate member will receive email member updates, notices and the quarterly ADE publication and can participate in discussions and networks and in line with the ADEA Constitution cannot vote, hold office or apply for recognition as a Credentialled Diabetes Educator.

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INTERNATIONAL ASSOCIATE MEMBER: Annual Fee $327.00 (includes GST)
An international associate membership is open to those who reside outside Australia and is available to any person working or with an interest in diabetes education. An international associate member will receive electronic member updates, notices and the quarterly ADE publication and can participate in discussions and networks and in line with the ADEA Constitution cannot vote, hold office or apply for recognition as a Credentialled Diabetes Educator.

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STUDENT MEMBERSHIP: Annual Fee $132.00 (includes GST)
Membership for Student - $128

Personal Details

TitleDrMrMrsMsMissProf

First nameLast name

Date of Birth

GenderMaleFemale

Email Address

Subscribe to ADEA e-NewsletterYesNo

Subscribe to Australian Diabetes Educator (ADE) PublicationYesNo

Subscribe to Diabetes Australia (DA) PublicationsYesNo

Address

Home

Address

Suburb

Postcode

StateNoneAustralian Capital TerritoryNew South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern AustraliaOverseas

Country

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Postal Address

Postal Address

Postal Suburb

Postal Postcode

Postal StateNoneAustralian Capital TerritoryNew South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern AustraliaOverseas

Postal Country

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Workplace
Please note that these details will not be displayed in ADEA’s “Find a CDE” search function on the front page of our website.
(For CDEs, please go to the Clinics Tab and enter your information there for publication). If you are an ADEA registered mentor and choose to have your details available to mentees on the ADEA website, your workplace address will be visible in the Find a Mentor listing.

Workplace name

Address

Suburb

Postcode

StateNoneAustralian Capital TerritoryNew South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern AustraliaOverseas

Country

Contact Details

Preferred contact methodEmailWork PhoneHome PhoneMobile PhonePost / Mail

Phone (Home)

Phone (Workplace)

Mobile Phone

Language

Do you speak any languages other than English?NoYes

Which language?

Do you use this language in your workNoYes

Do you identify as an Aboriginal and/or Torres Strait Islander?NoAboriginalTorres Strait IslanderAboriginal and Torres Strait Islander

Qualifications

Primary DisciplineRegistered Nurse (RN or Division one)RN/RM (Registered Nurse and Registered Midwife)
Direct Entry MidwifeAccredited Practising Dietitian
Registered Medical PractitionerRegistered Pharmacist
Registered PodiatristAccredited Exercise Physiologist
Registered PhysiotherapistAboriginal Health Practitioner
Aboriginal Health WorkerAged/residential Care worker
DentistEnrolled Nurse (EN)
Nurse AssistantOccupational Therapist
OptometristPsychologist
Social WorkerCompany Representative
Other

Other Primary qualification

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Advanced/Specialty QualificationsAccredited PharmacistAdvanced Accredited Practising Dietitian
Certificate in Fitness (Fitness instructor)Certified Product (Insulin Pump/CGM) Trainer (CPT)
Endorsed Nurse PractitionerMedical Specialist (eg Endocrinologist, Ophthalmologist)
Research (PhD / Masters)

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Diabetes education qualificationCertificate III Diabetes Management in General Care Setting
Graduate Certificate in Diabetes Education / Care
Graduate Diploma in Diabetes Education / Care
Masters Degree - Coursework - in Diabetes Education / Care
Masters Degree - Research - in Diabetes Education / Care
Non-award Course in Diabetes Education / Care
PhD - in Diabetes Education / Care
Other

Other Diabetes education qualification

Areas of practice

Academic0-20%21-40%41-60%61-80%81-100%

Clinical0-20%21-40%41-60%61-80%81-100%

Education0-20%21-40%41-60%61-80%81-100%

Research0-20%21-40%41-60%61-80%81-100%

Other Area of Practice

Professional Experience

Professional ExperienceAged CareCALD (Culturally and Linguistically Diverse Population)Carb Counting
CardiacCGMDesigning education programs
Diabetes in Developing CountriesDiabetes in PregnancyDiet and Nutrition
Exercise programsFertilityFootcare
GDMHealth Professional EducationIndigenous health
Medication ReviewMental HealthPaediatrics
Pre DiabetesPumpsRenal
ResearchWeight loss / BariatricsWriting for consumers
Writing for publicationOther

Please list specific CALD population/s

Other Specialty

How many year's experience do you have in diabetes related work?

Special Interest Groups

Available SIGCommittees
Diabetes in Pregnancy
Private practice
Working parties

Primary Workplace

Time spent in diabetes educationNot involved in the speciality of Diabetes Education/Care< 0.2 FTE= 0.2 < 0.5 FTE< 0.5 < 1.0 FTE≥ 1.0 FTE

Current position requires ADEA CDE statusYesNoNot Available

Work SectorPlease selectAboriginal medical serviceCommunity health service or centreDiabetes CentreGeneral practiceGovernmentNon-government organisation (e.g. Diabetes Australia)Not working at the momentNursing organisationPharmaceutical or diagnostic companyPrimary Health NetworkPrivate health care organisation (e.g. disease management organisation, Private health fund)Private hospitalPrivate practicePublic hospitalResidential Aged Care FacilitySelf-employedUniversity or other training organisationOther

Other Work Sector

Do you provide outreach services?YesNo

If yes, What services do you provide?Outreach by phone
Outreach by travel
Outreach by video link

Role at workDiabetes EducatorDietitan
Doctor/Medical specialistExercise Physiologist
General NurseManager
MidwifeNurse Practitioner
PharmacistPhysiotherapist
PodiatristPrimary Health Care Nurse
ResearcherStaff educator
Teacher/LecturerTelephone Service
Other

Role at work other

Workplace RegionInner Regional
Major Cities
Outer Regional
Remote
Very Remote

Please check your postcode on this Map and based on the colour choose the respective location
www.doctorconnect.gov.au/internet/otd/publishing.nsf/Content/locator

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Secondary Workplace

Time spent in diabetes educationNot involved in the speciality of Diabetes Education/Care< 0.2 FTE= 0.2 < 0.5 FTE< 0.5 < 1.0 FTE≥ 1.0 FTE

Current position requires ADEA CDE statusYesNoNot Available

Work SectorPlease selectAboriginal medical serviceCommunity health service or centreDiabetes CentreGeneral practiceGovernmentNon-government organisation (e.g. Diabetes Australia)Not working at the momentNursing organisationPharmaceutical or diagnostic companyPrimary Health NetworkPrivate health care organisation (e.g. disease management organisation, Private health fund)Private hospitalPrivate practicePublic hospitalResidential Aged Care FacilitySelf-employedUniversity or other training organisationOther

Other Work Sector

Do you provide outreach services?YesNo

If yes, What services do you provide?Outreach by phone
Outreach by travel
Outreach by video link

Role at workDiabetes EducatorDietitan
Doctor/Medical specialistExercise Physiologist
General NurseManager
MidwifeNurse Practitioner
PharmacistPhysiotherapist
PodiatristPrimary Health Care Nurse
ResearcherStaff educator
Teacher/LecturerTelephone Service
Other

Role at work other

Workplace RegionInner Regional
Major Cities
Outer Regional
Remote
Very Remote

Please check your postcode on this Map and based on the colour choose the respective location
www.doctorconnect.gov.au/internet/otd/publishing.nsf/Content/locator

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Code of conductI hereby agree to abide by the ADEA Code of Conduct.