Request Form for Help with B1/B2 Visa-related issues by APPNA Advocacy/Legislative & Young Physicians Committees
I herby authorize the chairs of APPNA Advocacy/legislative and Young Physicians Committees to contact U.S Department of State, and other Government and legislative authorities (as deemed necessary) on my behalf.
Name (First and Last) *
Email *
Date of Birth (month, day, year) *
MM
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DD
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Gender *
Visa Type *
Visa Status *
Reason for Visa Application (specify USMLE Exam OR Elective/Observorship/research program - speciality, name, city, state) *
Passport Country Name *
Passport Number *
Visa Processing Number *
Place (City) of Interview *
Date of Interview (month, day, year) *
MM
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DD
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YYYY
Name of Medical College *
Brief Description of Events *
Submit
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