Student Membership – Australian Islamic Medical Association

First Name

Last Name

First Name Required Last Name Required

Address Line 1:* Address Line 1 is Required

Address Line 2: Address Line 2 is not valid

City:* City is Required

Country:* Country is Required

State/Province:* State/Province is Required

Zip/Postal Code:* Zip/Postal Code is Required

Mobile No:* Mobile No is Required

Career Stage: Career Stage is not valid

University Name: University Name is not valid

* Student ID Number: * Student ID Number is not valid

Student ID Document : Student ID Document is not valid

Do you possess any unique skills or hold any positions that may benefit AIMA?: Do you possess any unique skills or hold any positions that may benefit AIMA? is not valid

Would you like to be added to our WhatsApp Group? WhatsApp groups are updated quickly with news and events.:* Would you like to be added to our WhatsApp Group? WhatsApp groups are updated quickly with news and events. is Required

Yes, Sure No

Primary place of work: Primary place of work is not valid

Seconday Place of Work: Seconday Place of Work is not valid

I'm interested in contributing to: I'm interested in contributing to is not valid

AHPRA Registered

Evidence of Academic or Professional Experience: Evidence of Academic or Professional Experience is not valid

APHRA registration number OR Professional Body Registration number: APHRA registration number OR Professional Body Registration number is not valid

Email: Email is not valid

Muslim_confirmation*

Aima Chapter: Aima Chapter is not valid

Profession Speciality: Profession Speciality is not valid

Specific Interest: Specific Interest is not valid

Email:* Invalid Email

Password:* Invalid Password

Password Confirmation:* Password Confirmation Doesn't Match

Password Strength Password must be "Medium" or stronger

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Sign-Up: Student

Pay Australian Islamic Medical Association