Application for the IAC International Board of Cytopathology Examination

Personal Information

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Date

I would like to sit the exam in:*

20. September 2024, Madrid, Spain, Universidad Europea de Madrid

7. November 2024 Orlando FL, USA (ASC annual meeting)

9. December 2024 Hong Kong, Prince of Wales Hospital

15. May 2025 22nd Int. Congress of Cytology, Florence, Italy

Your Given Name*

Given Name

Your Family Name*

Family Name

Your six digit membership number*

Your email*

Please enter your contact email

Phone*

The examinations are planned together with national cytology societies. Below is the list of currently planned examination sites.

Has your postal address changed recently?*

Yes

Where shall we send IAC postal correspondence?

If you enter your work address, please include department name and institute name.

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

Current Position*

Since*

Month/Year

Current Employer*

Name of employer

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

I am a certifiied specialist in my country of residence*

Yes

Please explain the qualification situation and regulations in your country*

I passed my specialist exam in (subject)*

Year*

Note of recommendation

A brief note of recommendation indicating how long your colleague or superior has know you and in what capacity. This does NOT have to be a Fellow or Member of the Academy.

You need an email of recommendation from a colleague or superior in the medical profession who can attest to your character and professional standards.

Email to support my application*

I have a colleague who will support my application

I do not have a colleague who can support my application

Please explain your situtation and why you can not name a colleague to attest to your professional standards*

Name of colleague to recommend your professional charachter*

Email address*

Please enter the email address of the colleague to support your application. When you submit this form an email will be sent to them automatically requesting a few lines in regard to your professional ideals.

Please upload a current copy of your CV*

Your current employment should be indicated.

Drop files here or

Accepted file types: pdf, jpg, png, Max. file size: 146 MB.

Please upload a passport sized photograph. For internal use only.*

Please do not upload a copy of your passport.

Accepted file types: jpg, png, pdf, Max. file size: 146 MB.

After submitting you will be directed to the payment page. Payment can be refunded if you are unable to attend.