AMSA Alumni Application

Title:

Surname: *

Given Name(s): *

Preferred postal address: *

Phone Number: *

E-Mail Address: *

University: *

Year of Medical Course Graduation: *

Date of Birth:

Member of AMSA executive/council/convention:

Convention/GHC/LDS attended:

Current Job/Title/Location:

Check the following membership options you would like to have: *

Your contact details added to the AMSA Alumni database

Password access to the AMSA Alumni Website and database

Invitations to AMSA Alumni reunion events

Exclusive AMSA Alumni newsletter

AMSA Monthly e-newsletter Embolus

A personal mailed copy of every edition of Panacea

Events

The Australian Medical Students' Association would like to thank our partners for all their support