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Form for WEST AFRICAN COLLEGE OF PH
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Form for WEST AFRICAN COLLEGE OF PH
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Title
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Prof
Dr
Mr
Mrs
Ms
Registrant Details
First Name
Last Name
Email
Email
Confirm Email
Phone Number
Faculty
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Community Health
Internal Medicine
Psychiatry
Paediatric
Family Medicine
Laboratory Medicine
Specialty
Specialty
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Anaesthesiologist
Cardiologist
Cardiothoracic Surgeon
Chemical Pathologist
Chemo Oncologist
Community Medicine
Community Dentistry
Dental Surgeon
Dermatologist
Health Physician
Ear, Nose & Throat Doctor (ENT)
Emergency Medicine
Endocrinologist
Family Medicine
Gastroenterologist
General Dentistry
General Medical Practice
General surgeon
Geriatrician
Haematologist
Haemato-Pathologist
Histopathologist
Implantologist
Internal Medicine
Medical Microbiologist
Mental Health
Nephrologist
Neurosurgeon
Neurologist
Obstetrician & Gynaecologist
Oncologist
Ophthalmologist
Oral and Maxillofacial Surgeon
Oral and Maxillofacial Pathology
Oral Radiologist
Orthodontist
Orthopaedic Surgeon
Paediatrician
Paediatric Cardiologist
Paediatric Dentist
Paediatric Surgeon
Pathologist
Periodontist
Plastic Surgeon
Prosthodontist
Psychiatrist
Public Health Physician
Pulmonologist
Radiologist
Restorative Dentist
Rheumatologist
Surgical Oncologist
Urologist
Others
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Country
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Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua & Barbuda
Argentina
Armenia
Aruba
Ascension Island
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia & Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
British Virgin Islands
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Canary Islands
Cape Verde
Caribbean Netherlands
Cayman Islands
Central African Republic
Ceuta & Melilla
Chad
Chile
China
Christmas Island
Clipperton Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo - Brazzaville
Congo - Kinshasa
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d’Ivoire
Denmark
Diego Garcia
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard & McDonald Islands
Honduras
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Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
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Kenya
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Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
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Lithuania
Luxembourg
Macao SAR China
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar (Burma)
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
North Korea
North Macedonia
Norway
Oman
Outlying Oceania
Pakistan
Palau
Palestinian Territories
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Samoa
San Marino
Sark
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia & South Sandwich Islands
South Korea
South Sudan
Spain
Sri Lanka
St. Barthélemy
St. Helena
St. Kitts & Nevis
St. Lucia
St. Martin
St. Pierre & Miquelon
St. Vincent & Grenadines
Sudan
Suriname
Svalbard & Jan Mayen
Sweden
Switzerland
Syria
São Tomé & Príncipe
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad & Tobago
Tristan da Cunha
Tunisia
Turkmenistan
Turks & Caicos Islands
Tuvalu
Türkiye
U.S. Outlying Islands
U.S. Virgin Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Wallis & Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Mode of Participation
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Physical
Virtual
Currency
Currency
NGN
USD
Membership Status
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Fellow
Member
Resident
Accompanying Person
Fellows
Amount
Quantity
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1
2
3
4
5
Members
Amount
Quantity
- None -
1
2
3
4
5
Residents
Amount
Quantity
- None -
1
2
3
4
5
Accompanying Person
Amount
Quantity
- None -
1
2
3
4
5
Inductee
- None -
Membership Inductee
Fellowship Inductee
Payment
amount
