Membership of ICOMAA, Canada

GIVING BACK TO A CENTER OF EXCELLENCE

Membership is open to former students of the University College/University of Ibadan who completed their program and reside in Canada.

Fields marked with an * are required.

Membership Type *

Salutation *

First Name *

Other Name

Last Name *

Surname at Graduation *

Email Address *

Phone Number *

Sex *

Address 1 *

Address 2

City *

Province *

Postal Code *

Year of Admission *

Matriculation Number (Optional)

Year of Graduation *

Program Graduated From *

Specialty *

Sub-Specialty

Type of Practice *

References should be classmates resident in North America.

Reference First Name

Reference Last Name

Reference Phone Number

Reference Email

Reference Location

Account Email (Username) *

Password *

By checking this box I understand that my membership registration is not valid until my membership status is verified and payment is received. *