IAC Medical membership application form | The International Academy of Cytology

For this form you will require:

Information about your medical training and experience in the field of cytology
A copy of your medical degree
A copy of your specialist diploma
A short copy of your CV indicating your training and experience in cytopathology. In English.
A small photograph for internal purposes only.
Applications also require at least one sponsor who is an IAC member.

The names of accepted members are added to the IAC list of new members and the list of active members In the IAC members area.

Personal Information

Hidden

Date

Your Given Name*

Given Name

Your Family Name*

Family Name

Your date of birth*

Please enter your date of birth beginning day/month/year

Your email*

Please enter your contact email

Phone*

Where shall we send your journal and IAC postal correspondence?

Please enter a full postal address. If your work address please include the department.

Please do not try to fit your address on one line.

Address Line 1*

Address Line 2

Address Line 3

City / Town*

Postal Code

(If required) State / Region /Province

Not every address requires a state

Country*

Your professional information

Your current position*

Current Employer*

Name of employer/ Your name if self-employed

Your work address, if Hospital or Medical Center include name of institute and department*

Your medical degree and training

Medical Degree (Year)*

Name and address of School / University / Institute*

Where do you achieve your medical degree?

Specialist Training

Where did you receive your specialist training?*

University/Hospital/Institute. Name and address.

I am a certifiied specialist in my country of residence.*

Yes

No

I passed my specialist examination in (subject):*

Year*

The qualification situation in my country*

Please describe the qualifications you gained that are necessary for you to practice cytopathology in your country of residence.

Required documents

Please upload a copy of your specialist certificate*

Accepted file types: pdf, jpg, png, Max. file size: 1 MB.

Your CV should clearly indicate your training and experience in cytopathology or clinical cytology

Does your CV clearly indicate your expereince and training in cytology?*

Yes, my training and experience is recorded in my CV

No, there is no mention of cytology training in my CV

Please indicate where and when you gained your experience and training in all aspects of cytopathology

Please upload a copy of your CV*

Drop files here or

Accepted file types: pdf, jpg, png, Max. file size: 1 MB.

Publications (last four years only)

Drop files here or

Accepted file types: pdf, jpg, png, Max. file size: 1 MB.

Please upload a passport sized photograph*

This picture will not be published and is for internal reference only.

Accepted file types: jpg, gif, pnd, pdf, Max. file size: 1 MB.

Phone

This field is for validation purposes and should be left unchanged.

Personal Information

Where shall we send your journal and IAC postal correspondence?

Sponsors

Your professional information

Your medical degree and training

Specialist Training

Required documents