Membership application

Complete the form below. The Association's secretary reviews every application.

Back to Membership

Fields marked * are required.

Personal information

First name

Last name

Professional title or academic degree

Email address

Telephone number

Country of residence

City of residence

Professional information

Current professional position

Medical specialty

Subspecialty

Hospital, clinic, university or other institution

Department

Work city

Work country

Years of professional experience

Education and qualifications

Medical or professional qualification

University or awarding institution

Graduation year

Specialty training, residency or fellowship

Professional licence or registration details

Board certification or other qualifications

Membership details

Reason for joining

Supporting documents

PDF, JPG or PNG, up to 5 MB each.

Curriculum vitae

Choose fileNo file chosen

Degree or qualification certificate

Choose fileNo file chosen

Proof of professional registration

Choose fileNo file chosen

Specialty training or board certification

Choose fileNo file chosen

Endorsement or recommendation letter

Choose fileNo file chosen

Declaration

I confirm that the information I have provided is accurate.

By submitting this form you agree that the Association will use the information and documents above to review your application and, if you are accepted, to administer your membership, as explained in the privacy notice.

Your application and documents are private and visible only to authorised staff of the Association. Read the privacy notice