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Intensive and Critical Care Society of Nigeria- Registration & Membership Update
* Indicates required question
1. Surname
*
Your answer
2. First name
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Your answer
3. Other name
Your answer
4. Gender
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Female
Male
5. Email address
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Your answer
6. Phone number
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Your answer
7. Cadre
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Consultant
Senior registrar
Registrar
Medical officer
Other:
8. Hospital of practice
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Your answer
9. Location of practice
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Your answer
10. Primary specialty
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Anaesthesia
Intensive care medicine
Surgery
Internal medicine
Emergency medicine
Paediatrics
Other:
11. If Surgery, please indicate specialty
Your answer
12. If Internal medicine, please indicate specialty
Your answer
13. Category of Membership
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Full member (Medical specialists based in Nigeria with evidence of training and practice or significant contribution to the field of Intensive Care Medicine)
Trainee member (Medical specialist in training)
International affiliate member (Medical specialists outside Nigeria with evidence of training and practice or significant contribution to the field of Intensive Care Medicine)
14. Provide evidence of Intensive Care Medicine training/ practice
*
Your answer
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