IAC Cytotechnologist Membership Application Form Step 1 of 3 33% Personal InformationHiddenDate MM slash DD slash YYYY Your Given Name(Required)Given Name Your Family Name(Required)Family Name Your date of birth(Required)Please enter your date of birth beginning day/month/year MM slash DD slash YYYY Your email(Required)Please enter your contact email Phone(Required)CT(IAC) number Year of exam Last sticker(Required) 2024-2027 2023-2026 2022-2025 2021-2024 Where shall we send your journal and IAC postal correspondence?If you enter your work address, please include department name and institute name.Address Line 1(Required) Address Line 2 Address Line 3 City / Town(Required) Postal Code (If required) State / Region /Province Not every address requires a stateCountry(Required)AfghanistanAlbaniaAlgeriaAndorraAngolaAnguillaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBrunei DarussalamBulgariaBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaCongo, Democratic Republic of theCongo, Republic of theCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFaroe IslandsFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMartiniqueMauritaniaMauritiusMexicoMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamYemenZambiaZimbabweOTHER Your employmentName and address of your current employer(Required)Employment started(Required)Month and Year Do you have any special field of interest in cytology?SponsorsName and email of and IAC member of the Academy sponsoring your applicationSponsor Name (Single name only)(Required) Sponsor email(Required) Application Statement(Required) I agree to application statementI successfully passed the C.T.(I.A.C.)-Registry examination and I desire to become a Cytotechnologist Member of the International Academy of Cytology, and if elected by the Board of Diretors of the Academy, I hereby promise that, so long as I continue to be a Cytotechnologist Member of the Academy, I will, to the utmost of my power, promote the honor and interest of the said Academy and observe the enactments of its Constitution and By-Laws, both as they now are and as they may from time to time be altered. I understand that – if elected – I can carry the abbreviations C.M.I.A.C. in addition to C.T.(I.A.C.) behind my name. Cytotechnologist Membership is predicated to maintenance of a valid Cytotechnology Registry Certificate by the International Academy of Cytology.