Contact – Iraqi Society For Histopathologists (ISHP)

Membership Application Form

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Personal Information

Full Name*

Gender*

Date of Birth*

Phone*

Email*

Address*

Professional Information

Current Workplace*

Job Title*

Academic Qualification | Bachelor of Medicine and Surgery (MBChB) – Date Obtained

Academic Title (if any)

Years of Experience after Specialization or as a Practitioner

Membership in Other Medical Societies (if any)

Declaration

I hereby declare that all the information provided in this application is accurate and complete. I undertake to abide by the bylaws and regulations of the Iraqi Society of Histopathologists and to fulfill all financial obligations.

Applicant’s Signature

Applicant’s Name*

Required Attachments

Copy of Bachelor’s and Specialty Certificates

Copy of National ID and Residence Card

Employment ID or Retirement ID

Recent Personal Photograph

Annual Membership Fee (100,000 IQD For full membership, 25000 IQD For Board Trainee Membership)

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(ISHP) The Iraqi Society For Histopathologists