Change of Practice Address/es Form

AMT requires all changes to practice address details in writing, please use this form to make changes to your practice details.

Do not use this form if you only need to change the business name for an existing address, please just email info@amt.org.au to request to update the name of the business.

If you are a new member or have just upgraded from student membership, please do not use this form, you will need submit your practice details here.

There is a tax-deductible administration fee of $30.00 including GST, for all practice address additions. There is no fee attached to removing a practice address.

The following terms and conditions apply to practice additions:
- The administration fee is non-refundable
- You are responsible for ensuring that the submitted address details are correct, including shop, suite and street numbers, spelling of street names, suburbs, states and postcodes
- Addresses can only be for confirmed practice locations and not for positions you are in the process of applying for
AMT undertakes to:
- Process all new practice addition requests within 2 business days
- Contact you via email when the new practice address has been added
- Provide a tax invoice/receipt for the administration fee so you can claim it as a business expense
I understand and agree to the terms and conditions for adding a practice*

YesNo
Please note all changes to practice details take 4-6 weeks from the date they are processed on our system to be sent to the health funds.

Full Name*

First NameLast Name
AMT Membership Number*
Email*
example@example.com
I would like to*

Add a practice addressDelete a practice addressAdd and Delete a practice address

Delete Practice Address
Company Name (if applicable)
Address*

Street Address

Street Address Line 2

SuburbState

Postcode
Practice Phone Number*
Date Left address*

DayMonthYear
Which of these options best describes why you need to delete a practice address?*

I am self-employed in my own business and have moved locationsI am self employed in my own business and no longer working from this addressI am a contractor and have moved to a new practice locationI am a contractor and no longer work from this practice locationI was applying for a job but didn't get it so I won't be working from this practice addressOther
Is this change connected to the COVID-19 pandemic?*

YesNo

Should be Empty:

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Add Practice Address

Delete Practice Address