How to Become a Member

A. Personal Details *

First

Last

Date of Birth *

Sex *

Male
Female

Nationality *

Qualifications: YEAR *

UNIVERSITY/ AWARDING BODY *

DEGREE *

Present Job/Position *

Subspecialty/Interests *

Memberships of Professional Organizations *

B. Contact Information:- Mailing Address *

Telephone : (H) *

(W) *

(Cell) *

Email *

C. Signature *

Date *

D. Membership Category: *

Ordinary (Postgraduate Paeds qualification)
Associate (Residents, Medical practitioners whose practice includes child health)
Extra-regional
Honorary

(Significant Caribbean Child Health contributions recognized by CCP)

E. Proposers:

Required by interested applicants who do not hold a postgraduate qualification in Paediatrics. Proposers, registered members of the CCP, are requested to provide a letter of support..

Supporting Letter

Click or drag a file to this area to upload.

Name

Phone Number

Fax

Date

(2). Name

Phone Number

Fax

Date

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