Islamic Medical Association of Queensland (IMAQ) Registration
Kindly note that IMAQ membership is for Muslim Health Professionals Only

Membership Fees:
- Graduated Professionals: $50 sign-up fee
- Students: Free

Please transfer your membership fee to the IMAQ Treasurer with the following reference:

SURNAME, First Name IMAQ

Details: WESTPAC
Account Name: Islamic Medical Association of QLD
BSB: 034-182
Account Number: 233627

Sign in to Google to save your progress. Learn more
Title *
Required
First Name *
Surname *
Email *
Mobile Phone No. *
Suburb *
Occupation *
Required
Please state your PRIMARY QUALIFICATION (e.g. MBBS) and the YEAR  in which you achieved/will achieve this qualification *
Professional Body Registered *
If you answered MEDICAL PRACTITIONER for OCCUPATION, please specify stage of training
If you selected Registrar or Specialist/Visiting Medical Officer, please specify specialty below
If you have a SUBSPECIALITY (e.g. Surgery - Urology; Physician - Cardiology), please specify below
If you answered STUDENT for OCCUPATION, please specify your study program
Primary Place of Practice/Study (if unsure, refer to https://www.health.qld.gov.au/maps) *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms