Association for Excellence in Medical Education

Request for Membership

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Instructions: Please read carefully the form before sending to AEME of n con
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Membership Types
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Individual Membership
or thr
Benefits:
ee m
Regular mailings about AEME conferences and activities
embe
10% discount on conference registration and priority will be given in
rs an
workshops when seats are limited .
d prio
Voting right
rity w
Exchange of information at all levels
ill be
Regular news of AEME and of other bodies concerned with medical education given
via electronic
in
communication.
User login ID and password to access the website material.
works
hops
Annual Fee is waived for the years 2015,
FEE Annual: Rs. 12, 00/ , US$ 100
when
2016 & 2017
How to apply: Apply Online. Or download the form and send us on the given seats
address with
are
demand draft in favor of AEME .
limite
d.
Student Membership

Benefits:
Regular mailings about AEME conferences and activities
Partic
Exchange of information at all levels
ipatio
User login ID and password to access the website material.
n& d
10% discount on conference registration
iscou
Cost: RS. 750/ or US$75 for one year
nt on
How to apply: Apply Online. Or download the form and send us on the given AEME
address with
Educ
demand draft in favor of AEME .
ators
& Bus
Institutional/Group Membership
iness
Benefits:
Foru
Personal copy of AEME Proceedings & Newsletter
ms
Institutional members have the right to send a representative of the

institution to Council who

can participate in AEME activities (representatives attending Council meeting Votin
g Rig
s should seek
hts fo
reimbursement of travel expenses from their own institution)
r thre
Receipt of regular mailings containing details of forthcoming courses and
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conferences along with
mber
information on current AEME publications
s

Reduced cost for exhibitions at AEME conferences

Sharing of research material

Bio data :
Prefix:
Dr. ____
ease specify):

Professor ____

Mr. ____

Mrs. ____

Ms. ____

Other (pl

_______________
Gender: Male ____ Female ____
First Name:

______________________ Middle Initial(s): _______

Last Name: _______________________

Postal Address:
_________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
City: _____________________________________________

Country: __________________________________________

Telephone: ________________________________________

Fax: ______________________________________________

Email Address: _____________________________________

Website: __________________________________________

Academic/Professional Degree(s): ____________________________________________________________________________

Discipline/Specialty: Please select one discipline from the list of AEMErecognized disciplines/specialties on page 3.
Present Afliation (place of employment):
Pharmaceutical: ____
Name of Employer:

Hospital/Clinic: ____

University: ___

Private Business: ____

________________________________________________________________________________________

___________________________________________________________________________________________________ _____

Occupation: Administrator
Basic Researcher

____

Clinician ____

____

Educator ____

Clinical Researcher ____

Other (please specify)______________________________

Discipline/Specialty (please select only one):

___ Acupuncture

___ Midwifery

___ Pathology

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Alternative Medicine
Anesthesiology
Anthropology
Cardiology

Neurology
NeurophysiologyClin
Neuroscience
Neuroscience/Neurobiology

Pediatrics
PharmacologyClin
Pharmacy
Philosophy

User login ID and password to access the website material.

Annual Fee: USD 1000 or Rs. 10,000
How to apply: Apply Online. Or download the form and send us on the given add
ress with
Demand draft in Favor of AEME.

___
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Chiropractic
Dentistry/Oral Medicine
Dermatology
Emergency Medicine
Endocrinology
Epidemiology
Family Medicine
Gastroenterology
General Medicine
General Surgery
Geriatric Medicine
Health Administration
Hematology
Internal Medicine
Law
Media
Medical Publisher
Medical Technology
Medical Writer

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Neuroscience/Neuropharmacology

___ Physical Med & Rehabilitatio

Neuroscience/Neurophysiology

Neuroscience/Neuropsychiatry

Neurosurgery

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Nuclear Medicine

ed

Nursing

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Neuroscience/Pharmacology
Neuroscience/Physiology

Obstetrics/Gynecol
Occupational Medicine
Occupational Therapy
Oncology
Ophthalmology
Orthopedic Medicine
Orthopedic Surgery
Osteopathic Medicine
Otolaryngology
Pain Medicine
Palliative Medicine

Physical Therapy
Plastic Surgery
Primary Care
Psychiatry/Psychosomatic M
Psychology
Public Health
Radiology
Research & Development
Rheumatology
Social Sciences
Sports Medicine
Statistics
Trauma Surgery
Urology
Veterinary Medicine
Other (please specify):

__________
Area(s) of special interest or work in the field (please specify): ________________________________________________
________________________________________________________________________________________________________

Signature of Applicant

For AEME Office Use Only:

ipt:
____________

ID #: _________

Method of Payment: _____________________

_____________________

Date

Date Received: _____________

Type: _____________

Method of Rece

SIGs:

AEME Dues Payment Form

Membership Details:

1.

Individual Membership
Rs. 12,00/ , US$ 100 for one year
2. Student Membership
RS. 750/ or US$75
3. Institutional/Group Membership
USD 10,00 or Rs. 10,000 per year
Please send your completed Application for Membership, dues payment using one of the following methods:
Via the Post:

Association for Excellence in Medical Education Office ,

Lehtrar Road Farash Town
Islamabad Pakistan
Via Fax:
Via Email:

+92 51 8439920
aeme@ae-me.org

For assistance
If you have questions about completing and submitting the Application for Membership, including the Dues Payment
Form, please call the AEME Office at +92-51-8439901-10, ext. 3025.
For more information about AEME, please visit our website: www.ae.me.org

Method of Payments:

Please make your Bank Draft payable to Association for Excellence in Medical Edu
cation and on the
reverse side of the bank draft, please indicate "AEME Mail your bank draft to ad
dress given at end:
OR
TT
Account No. 02011975090
Beneficiary. Association for Excellence in Medical Education
Branch: Soneri Bank Lehtrar Road Islamabad Branch
Bank's Phone No: 92 51 22416646