*Click here to download a copy of the Ordinary Membership form
Surname Other Names
Attach Recent Passport Photo (*Max File Size is 5MB)
Age
Gender —Please choose an option—FemaleMale
Citizenship
First Medical Qualification (State Award, Training Institution, Year of award and Country of Training)
Attach Qualification Certificate (*Max File Size is 5MB)
Additional Medical Qualifications (State Award, Training Institution, Year of award and Country of Training)
Current Employer
Current Work Station
Job Title
Current Work City/Town/District
Current Profession
Professional Council Where Registered
Attach Copy of Registration Certificate (*Max File Size is 5MB)
Speciality
Sub Speciality
Year of First Registration with IMAU
IMAU Parent Local Branch Where Membership Fee is Paid —Please choose an option—Apac/LiraAruaHoimaIgangaJinjaKampalaKapchorwaKobokoMbaleMbararaMpigiMubendeMukonoPallisaSorotiSouthern RegionTooroTororoWakisoYumbe
Membership Fee Paid for the Year
Attach a Copy of the Membership Fee Receipt (*Max File Size is 5MB)
IMAU Countrywide Operational Branch NoneIMAU Women's BranchIMAU Student's Branch
Current Work Station Physical Address
Personal Email
Personal Mobile Phone(s)
Permanent Home Address
I am applying for IMAU Ordinary membership for the first timeI am updating my IMAU Ordinary Membership
I have read and understood the constitution of IMAU and I agree to abide by it and the objectives and obligations of the Association
*Click here to download a copy of the Associate Membership form
Surname
Other Names
Attach Recent Passport Photo (*Max File Size is 5MB) Age
Course/Program
Year of Study
Name of Institution
Attach Student Identity Card (*Max File Size is 5MB)
Attach Student Admission Letter (*Max File Size is 5MB)
Planned Qualifications on Completion of Studies
Planned Profession on Completion of Studies
Planned Professional Council to be Registered With on Completion of Studies
IMAU Parent Local Branch Where Membership Fee is Paid —Please choose an option—Apac/LiraAruaHoimaJinjaKampalaKapchorwaMbaleMbararaMpigiMubendeMukonoPallisaSorotiSouthern RegionTooroTororoWakisoYumbeNot Applicable
Current Address
Email
Mobile Phone
Tick whichever is applicable I am applying for IMAU Associate membership for the first timeI am updating my IMAU Associate Membership
Terms and Conditions Section I have read and understood the constitution of IMAU and I agree to abide by it and the objectives and obligations of the Association
*Click here to download the Honorary Membership Acceptance form
Qualification(s)
Profession
