עמוד בית
Thu, 31.10.24

Application for the IMA World Fellowship

I hereby apply for admission to the IMA as a member of the World Fellowship:

How did you hear about us?

Qualified Physician

Last Name:
First Name:
Title:
Date of birth:
Gender:
Country:
City:
Address:
Work Address:
Field of Medicine:
Tel. No.:
E-mail Address:
Mobile no.:
Fax:
Specialization:
Workplace:
Potential volunteer:
WF Branch role:

Medicine Student

Last Name:
First Name:
Date of birth:
Gender:
Country:
City:
Address:
University:
Year of Graduation:
Tel. No.:
E-mail Address:
Mobile no.:
Fax:
Specialization:
Workplace:
Potential volunteer:
WF Branch role:

I agree/disagree that my details be given to other members.

Legal Disclaimer: The information contained in this website is provided for informational purposes only, and should not be construed as legal or medical advice on any matter.
The IMA is not responsible for and expressly disclaims liability for damages of any kind arising from the use of or reliance on information contained within the site.

© All rights to information on this site are reserved and are the property of the Israeli Medical Association. Privacy policy


2 Twin Towers, 35 Jabotinsky, POB 4292, Ramat Gan 5251108 Israel