Membership Application

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Please verify your eligibility before applying. By applying here, you agree to our Terms of Service/Privacy Policy. The final decision to approve or dismiss your application is taken by the PeMSAA-UK Executive Committee. In case you made a mistake, please submit a corrected form and inform us via info@pemsaa.uk

First Name *

Last Name *

Job Title *

Year of entry to Peradeniya Medical School
*

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Your Email
*

Postal Address

City

Postal/Zip Code

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Your Phone Number

Please choose the type of membership you need
*

Please indicate how you would like to pay the membership fee
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Comments/Notes

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