Membership Application and Checkout - Caribbean Medical Student Association

Membership Information

You have selected the Professional School membership level.

For students enrolled in medical, dental, nursing, pharmacy, physician assistant, public health, allied health, or other healthcare professional programs.

The price for membership is $15.00 per Year.

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Basic Information & Demographics

First Name

Last Name

Date of Birth

Gender

Email Address

Phone Number

Mailing Address

(City, State/Province, Zip/Postal Code, Country)

Do you identify as being of Caribbean heritage?

Country of birth

Do you currently reside in the Caribbean?

Languages Spoken

Which best describes you

Professional School Student Membership Application

Undergraduate Institution Name

Enter the name of the undergraduate school you have attended

Undergraduate Degree and Year Earned

Professional School Institution Name

Enter the name of the professional school you are currently attending

Degree Program

Current Year in School

Graduation year

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Membership Information

Account Information

Basic Information & Demographics

Professional School Student Membership Application

Interest and Involvement

Membership Consent