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The information supplied in this Application for Corporate Membership is complete and accurate. You agree to give notice in writing to Sydney Medical Service 1300HOMEGP of any changes to the information supplied in this Application for Corporate Membership as soon as is reasonably practicable.
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If this Application for Corporate Membership is accepted, the Medical Practitioners named in the application will be entitled to receive the benefits of membership of Sydney Medical Service 1300HOMEGP (subject to the Rules of Sydney Medical Service 1300HOMEGP). Each Medical Practitioner will be bound by the Rules of Sydney Medical Service 1300HOMEGP.
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If any other Medical Practitioner commences at the surgery nominated on this Application for Corporate Membership and wishes to receive the benefits, you will immediately notify Sydney Medical Service of the details of such Medical Practitioner and agree to Sydney Medical Service charging a revised subscription fee based upon the number of Medical Practitioners who shall receive the benefit of the services provided by Sydney Medical Service.
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If any Medical Practitioner listed on this Application for Corporate Membership leaves the practice, notice will be given to Sydney Medical Service as soon as reasonably practicable of departure because that Medical Practitioner leaving the nominated practice will no longer be entitled to the benefits of membership of Sydney Medical Service.
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Sydney Medical Service will serve notices on the Corporate Members by issuing such notices to the Principal Representative nominated on this Application for Corporate Membership (in accordance with its Rules).
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You, and each of the Medical Practitioners listed on this Application for Corporate Membership, are aware of the boundaries and geographic regions presently covered by Sydney Medical Service and understand that:
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patients who reside outside of those boundaries will not be covered for after-hours care by Sydney Medical Service 1300HOMEGP; and
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it is your responsibility and that of the Medical Practitioners listed on this Application for Corporate Membership to make alternative after-hours arrangements for those patients.
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Signature of Principal Representative (on behalf of Corporate Member Applicant) *
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Name *
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Position *
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Date *
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