Aerospace Medicine International Membership Application Form
Aerospace Medicine International is a voluntary, non-profit organization, consisting of professionals from the field of aerospace medicine and allied disciplines, dedicated to support and advance aerospace safety across the globe. This professional association is funded solely by voluntary contributions of its members.

Thank you for your interest in joining Aerospace Medicine International.

Filling this form will take 3-5 minutes.

Full Name *
Your answer
e-mail ID *
Your answer
Telephone No. *
Your answer
Address for Communication (including Post Code) *
Your answer
Occupation *
Your answer
Name of Present Organisation *
Your answer
Your Designation in Present Organisation *
Your answer
Date of Birth (DDMMYYYY) *
Your answer
Please list your Highest Academic Qualification with University and Year of Obtaining the same. *
Your answer
Please list your Other Academic Qualifications with University and Year of Obtaining the same. *
Your answer
If you are a pilot, please state your current professional licence and number of flying hours. *
Your answer
If engaged in any aviation safety sensitive role, please state the name of the organisation and your designation?
Your answer
Please list membership of scientific association or society, if any.
Your answer
List of Scientific Publications, if any.
Your answer
Your Academic and Research Interest *
Your answer
How do you see yourself helping fulfill goals and activities of AMI? *
Your answer
Do you know any members of Aerospace Medicine International? *
If your answer above is yes and you wish those members to be your referee, please list their names. Please note AMI Membership Committee may contact them on your behalf.
Your answer
If your answer above was no, please list your referee(s) with their e-mail ID. Please note AMI Membership Committee may contact them on your behalf to decide your membership.
Your answer
Please confirm you have read the Constitution and Instructions for joining Aerospace Medicine International, and you agree to join the association. *
Submit
Never submit passwords through Google Forms.
This form was created inside of AvMed Consultations. Report Abuse - Terms of Service - Additional Terms