NORTH AMERICAN ACADEMY of AESTHETIC MEDICINE

Allied Health Practitioner Registration:

Eligibility and Requirements:

For membership as Medical/ Dental Practitioner, the delegate must have completed the following:

 Completed Basic Health related qualification, such as B. Pharm, D. Pharm, Pharm.D, BSc. Nursing, BSc. Pharm, BSc. Science, etc.
 Advanced health related Qualifications (if any), only 3 can be uploaded. Upload the most relevant to your practice.
 Must be licensed Allied Medical practitioner or a practicing practitioner in the city/ state of domicile. Workplace details must be provided.
 For more details on the selection criteria* on Allied Health please contact, memberships@naaamed.org, along with a detailed CV and a scan copy of educational certificates*.

NOTE:

*In cases like these all evaluations are done by the membership committee and a report is forwarded to the executive education board. The president along with the board gives the final decision on such cases. Decision by the board is final and if any action plan is given to the delegate the same must be followed, else the delegate risks losing the membership.

Before proceeding further, kindly make sure the following documents are available for attachment to this electronic form.

Personal Identification:

Government Issued ID** (Showing complete Doctor name and Father’s/ Husband’s Name)
   *Official Passport, Official Identification Card or Drivers’ License only. Hospital ID, Work ID will no be accepted as         an official document.
Passport Size Photograph
Educational Qualification/ Licensure:
Color Scan copy of the Basic Medical/ Dental Qualification
Color Scan copy of all Advanced Certifications/ Qualification, if mentioned in the e-form of registration
Color Scan copy of Licensure(s)
Updated CV/ Resume

New Allied Health Practitioner Membership FORM:

    Title*
    (For titles of ‘Doctor’, ‘Professor’, proof of completion of required certification/ postgraduate must be attached.)

    Personal Information:
    First Name*
    Middle Name*
    Last/Family Name *
    Date of Birth*
    Nationality*
    Country of Practice*
    Attach Government ID*
    (Passport, Official ID or Driver’s License)
    Attach Passport Size Picture*

    Contact Detail:
    Mailing Address, Line 1*
    Mailing Address, Line 2
    City*
    State*
    Country*
    Zip Code/ Postal Code*
    Contact Phone (Mobile)*
    Contact Phone (Home)*
    Contact Phone (Work)
    Email Address (Personal)*
    Email Address (Work)

    Social Media Details:
    WhatsApp Number*
    Instagram ID
    Facebook ID
    Linkedin ID
    Website

    Work/ Practice Place Details (If Practicing):
    Name of Work place
    City
    State
    Country

    Allied Health Education Details:
    Name of Basic Health Qualification*
    Date of Graduation*
    University of Awarding the Qualification*
    Country of Graduation*
    Attach Certificate*

    -------------------

    Any Advanced Certification and Qualifications 01
    Date of Completion
    Attach Certificate

    -------------------

    Any Advanced Certification and Qualifications 02
    Date of Completion
    Attach Certificate

    -------------------

    Any Advanced Certification and Qualifications 03
    Date of Completion
    Attach Certificate

    Practice Licensure Details (If Any):
    Practice License Number
    Practice License Issuing Country
    Attach License Copy

    Attached Any Additional Documents here:
    Attach CV/ Resume*
    Name to be printed on the Membership Certificate/ Card*

    Declaration:*