Membership Application

First Name

Middle Name

Last Name

Email Address *

Phone Number

Date of Birth

SexMaleFemale

Date of Graduation for Practice

Medical Council Registration NUMBER

Degrees with year obtained and issuing body0 / 180

Speciality to be practised

Home Address

Work Address

Marital StatusMarriedSingleWidowedDivorced

Home Telephone

Work Telephone

Fax

Cell

Other interests

NEW MEMBER - I am desirous of becoming a member of the Barbados Association of Medical Practitioners. PREVIOUS MEMBER - I am reapplying for membership in the Barbados Association of Medical Practitioners.

Member DesignationSpecialistGeneral PracticeJunior doctorInternMedical StudentRetiree

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