MOA Network - Member application

The Victoria Division of Family Practice has launched a new MOA Network and is now accepting member applications.

CONSENT OF INFORMATION USE

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* 1. All the personal information you provide will be kept confidential, but aggregated data may be used to develop the program. Your information will be stored on our secure server, located in the VDFP Office, and will be accessed only by project staff working on Division business, and for the purposes of completing their work.

By providing your information you agree to be contacted by the Victoria Division of Family Practice regarding ongoing MOA Network engagement and education opportunities, resources and updates.

* By completing this application, you are indicating your consent to the use of your information as described above.

I agree.

I disagree.

MEMBERSHIP & ELIGIBILITY

Although the Network's target audience is MOAs working in physician-owned family practices of the Victoria PCN, we welcome the participation of MOAs from UPCCs, CHCs and other government-funded clinics. Review member benefits.

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* 2. Confirm your eligibility below:

I work in a clinic that is part of the Victoria PCN

I am unsure if my clinic is part of the Victoria PCN, please follow up with me.

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* 3. What type of clinic do you work at?

A physician-owned family practice

A government-funded clinic (e.g., UPCC, CHC)