IAC Professional non-medical membership application form – IAC Tutorials Meetings only.

Email

This field is for validation purposes and should be left unchanged.

For this form you will require:

A copy of your Masters degree and any other specialist training and experience in the field of cytology
A short copy of your CV indicating your training and experience in cytopathology
Your publications of the last four years only
A small photograph for internal purposes only (selfie/headshot).
Applications also require a sponsor who is an IAC member.

The names of accepted members are added to the IAC list of active members In the IAC members area.

Personal Information

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Date

Your Given Name*

Given Name

Your Family Name*

Family Name

Your date of birth*

Please enter your date of birth beginning day/month/year

Your email*

Please enter your contact email

Phone*

Where shall we send your journal and IAC postal correspondence?

Please enter a full postal address. If your work address please include the department.

Please do not try to fit your address on one line.

Address Line 1*

Address Line 2

Address Line 3

City / Town*

Postal Code

(If required) State / Region /Province

Not every address requires a state

Country*

Your professional information

Your current position*

Current Employer*

Name of employer

Your work address, if Hospital or Medical Center include name of institute and department*

Your degree and training

Name of your degree*

Please let us know what field you attained your degree in.

I attained my degree (Year)*

Name and address of School / University / Institute*

Where do you achieve your degree?

Interest in Cytology

Training in Cytopathology or Clinical Cytology*

Please include dates as well as the names of University/Hospital/Institute. and address and your activities. (Full-time only)

Required documents

Please upload a copy of your degree*

Accepted file types: pdf, jpg, png, Max. file size: 900 MB.

Your resume should clearly indicate any training and experience in cytopathology or clinical cytology

Please upload a copy of your CV*

Drop files here or

Accepted file types: pdf, jpg, png, Max. file size: 900 MB.

Publications (last four years only)

Drop files here or

Accepted file types: pdf, jpg, png, Max. file size: 900 MB.

Please upload a small photograph. (Headshot/selfie)*

This picture will not be published and is for internal reference only.

Accepted file types: jpg, gif, pnd, pdf, Max. file size: 900 MB.

Personal Information

Where shall we send your journal and IAC postal correspondence?

Sponsors

Your professional information

Your degree and training

Interest in Cytology

Required documents