EMAT Membership Application
Please complete this application form and submit payment for Active Membership. If you only complete this form you will be considered a member but not an active member.

For more information visit: http://www.emat.or.tz/become-a-member.html

Title *
First name *
Your answer
Last name *
Your answer
Email address *
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Mobile/Cell Number *
Include country code if not +255
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Institution or Organization *
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Position *
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Nationality *
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City, Country *
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Membership Type *
NOTE: Affiliate Membership can apply to international members and students. Read description on the website for more information.
Interested in *
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Emergency Medicine Association of Tanzania
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