You’re offline. This is a read only version of the page.
Skip to main content
Back to AMA (WA)
Back to AMA (WA)
Toggle navigation
Membership
Membership
Student Membership
Join-Membership
Member Benefit
Sign in
Student Membership
Personal Details
Preferred Title
*
Dr
Mr
Miss
A/Prof
Prof
Ms
Surname
*
*
Given Name
*
*
Preferred Name
*
*
Date of birth
*
*
Gender
Male
Female
Non-binary
University
*
UWA
UND
CAMS
Oceanic University of Medicine
Year Level
*
Year 1
Year 2
Year 3
Year 4
Year 5
Intern Year 1
PGY2
PGY3
PGY4
PGY5
Contact Details
Email (We prefer you to use your personal email)
*
*
*
Mobile Number
*
*
Residential Address
*
Residential Address : Street 1
*
Residential Address : Street 2
*
Residential Address : Suburb
*
Residential Address : State
*
Residential Address : ZIP/Postal Code
*
Residential Address : Country/Region
*
How did you hear about AMA Membership
*
Medicus
Direct mail from the AMA
AMA event
University
Advice from Professional College
College referral (please provide name)
Other (please specify)
Please Specify
*
