Affiliate Membership Application Form

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I hereby apply for membership of the International Academy of Aviation and Space Medicine as:

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I subscribe fully to the objectives of the Academy. I am exercising clearly established functions and activities in the field of Aviation, Space Medicine, or related sciences as:

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In further support of this application, the following enclosures are submitted (in English or French):

1. Evidence of qualification in medicine or in an allied science; (photocopies of Degrees and Diplomas)

2. A Curriculum Vitae (maximum 5 pages) including:
a) A description of previous and present professional activities - highlight activities in aviation or space medicine;
b) A list of personal publications if any - list separately, or highlight, any aviation or space medicine publications;
c) A statement of aviation activities, including personal flight experience;
d) A statement of membership and status in professional and aeronautical societies.

3. A recent photograph;

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I agree to my application being retained by the Academy and circulated to officers and post holders of the Academy in accordance with its data protection policy. 

I certify that information contained in any document pertaining to my application for membership is accurate, and that any copy of a document which is submitted is a true representation of the original.

International Academy of Aviation and Space Medicine