IAC Junior Medical membership application form "*" indicates required fields Step 1 of 4 25% For this form you will require: A copy of your medical degree A letter/document from your course director confirming your post graduate training specialist trainingA 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 InformationHiddenDate MM slash DD slash YYYY Your Given Name*Given Name Your Family Name*Family Name Your date of birth*Please enter your date of birth beginning day/month/year DD slash MM slash YYYY 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 stateCountry*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 ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKoreaKuwaitKyrgyzstanLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMartiniqueMauritaniaMauritiusMexicoMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew 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 SudanSpainSri LankaSudanSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamYemenZambiaZimbabweOTHER SponsorYou will need a Member or Fellow to sponsor your application. Sponsor* I have a sponsor I am unable to find a sponsor Please explain your situation and why you do not know an Academy member who could sponsor you.*Sponsor Name*Please enter the name of your sponsor. Sponsor email*Please enter your sponsor contact email. When you submit this form an email will be sent automatically to your sponsor asking them to confirm. Your professional informationYour 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 trainingMedical Degree (Year)* Name and address of School / University / Institute*Where do you achieve your medical degree? Specialist TrainingWhere are you receiving your specialist training?*University/Hospital/Institute. Name and address.When do you anticipate you will complete your course* Required documentsPlease upload a copy of your medical degree*Accepted file types: pdf, jpg, png, Max. file size: 146 MB.Your CV should clearly indicate your training and experience in cytopathology or clinical cytologyDoes your CV clearly indicate your expereince and training in cytology?*At least one year full time training or experience in cytopathology is required. Yes, my training and experience in cytology 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 cytopathologyPlease upload a copy of your CV* Drop files here or Select files Accepted file types: pdf, jpg, png, Max. file size: 146 MB. Publications (last four years only) Drop files here or Select files Accepted file types: pdf, jpg, png, Max. file size: 146 MB. Please upload a passport sized photograph (Headshot)*This picture will not be published and is for internal reference only.Accepted file types: jpg, gif, pnd, pdf, Max. file size: 146 MB.Application Statement* I agree to the Application Statement.I desire to become a Member of the International Academy of Cytology, and, if elected by the Board of Directors, I hereby promise that, so long as I continue to be a 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 bylaws, both as they are now and as they may be altered from time to time.EmailThis field is for validation purposes and should be left unchanged.