Applicant Registration

This section is particularly dedicated for the guidance, mentorship, moral and financial help of all the upcoming Young Pakistani physicians who are pursuing for a spot in the academic fields of residency, fellowship, research work and electives.

PERSONAL INFORMATION:

AAMC ID:

*First Name:  Middle Name:  *Last Name:

*Email Address:

*Password: *Re-Enter Password:

 

PERMANENT ADDRESS (May be outside USA):

Address:

City: State: Zip:

Country:

 

PRESENT RESIDENTIAL ADDRESS (USA):

Address:

City: State: Zip:

 

OFFICE ADDRESS (USA):

Address:

City: State: Zip:

 

MAILING ADDRESS:

 

PHONE NUMBERS:

*Home: *Cell / Mobile: Work:

 

EDUCATION:

*Medical College:

*Degree Granted: MBBS MD DO Other      |     *Year degree granted:

if other, please specify:

 

EXAMINATION PASSED:

USMLE 1: Number of Attempts: Score:

USMLE 2 or CK: Number of Attempts: Score:

USMLE CS: Number of Attempts: Score:

USMLE 3: Num ber of Attempts: Score:

All the information regarding scores and number of attempts will be kept confidential.

 

ECFMG CERTIFICATED:

Yes No

 

CURRENT EMPLOYMENT:

Employer's Name:

Country:

Current Position:

Visa Status:

Explanations, if any:

 

* SPECIALTY OF INTEREST (May select more than one - USE CONTROL AND CLICK TO SELECT MULTIPLE):

 

*SERVICES REQUESTED (May select more than one - USE CONTROL AND CLICK TO SELECT MULTIPLE):

 

IN CASE OF REQUEST FOR LOAN:

Please include the reference of at least one active member of CYP or the organization, who can verify your information.

Name:

Address:

City: State: Zip:

Home Phone: Cell / Mobile: Office:

Email:

 

CERTIFICATION:

*By checking Yes, I solemnly declare that all of the above information provided by me is correct to the best of my knowledge. I am fully aware that any misinformation provided, even by mistake, is my own responsibility and my membership can be revoked because of that and I will be solely responsible in the court of Law, if any conflict arises. YES

NOTE: All the members:

  1. Receive e-news letters
  2. Attend seminars and meetings.
  3. Access to e-listing of premium professional opportunities.
  4. Access to social forums.
  5. Access to International medical graduate friendly program listing for residency and fellowship.
  6. Can request help for visa issues, accommodations, interest free loans and other services.

Disclaimer:  The application will be reviewed by the designated official and membership is subject to approval or disapproval with reason or without cause.