registration FORM
Medical Professionals (Non-AMSA member) African /Non-African USD Payment
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Title
Name
Profession
Affiliate institution / organization
Contact Address
Address
City
State
Zip Code
Country
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Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
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Argentina
Armenia
Aruba
Australia
Austria
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Bahrain
Bangladesh
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Belarus
Belau
Belgium
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Bhutan
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Bonaire, Saint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
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British Virgin Islands
Brunei
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Burundi
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Canada
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Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
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Croatia
Cuba
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Cyprus
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Democratic Republic of the Congo (Kinshasa)
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
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Fiji
Finland
France
French Guiana
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French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
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Guinea
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Guyana
Haiti
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Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
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Jamaica
Japan
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Jordan
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Kenya
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Kuwait
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Laos
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Libya
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Maldives
Mali
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Mayotte
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Morocco
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Myanmar
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Poland
Portugal
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Qatar
Republic of the Congo (Brazzaville)
Reunion
Romania
Russia
Rwanda
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin (Dutch part)
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia/Sandwich Islands
South Korea
South Sudan
Spain
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Sudan
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Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syria
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Tajikistan
Tanzania
Thailand
Timor-Leste
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Tonga
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Turks and Caicos Islands
Tuvalu
Türkiye
Uganda
Ukraine
United Arab Emirates
United Kingdom (UK)
United States (US)
United States (US) Minor Outlying Islands
United States (US) Virgin Islands
Uruguay
Uzbekistan
Vanuatu
Vatican
Venezuela
Vietnam
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
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Medical Professionals (Non-AMSA member) African /Non-African
Registration Fee $125
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