NORTH AMERICAN ACADEMY of AESTHETIC MEDICINE

Student Membership Registration:

Eligibility and Requirements:

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

 Medical Students (MD, MS, DO, MBBS, MBBChB, etc.) or Dental Students (BDS, DDS, MDS, DMD, etc.)
 Active enrollment in a recognized medical/ dental school
 Allied Health students may also apply, if they have documents proving their active enrollment in their respective course
 Letter of Enrollment from their university or medical school or color scan copy of student ID

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 university/ medical School enrollment or student ID card
Updated CV/ Resume

New Student 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

    Education Details:
    Name of Qualification Enrolled*
    Date of Enrollment*
    Expected Date of Graduation*
    University of Awarding the Qualification*
    Country of Graduation*
    Attach Certificate/Card*

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

    Declaration:*

    Need any help?

    If you need any assistance feel free to contact us ay time.