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Life Membership

Written by admin• July 29, 2026

Price:

$100

First Name: First Name Required

Last Name: Last Name Required

Address Line 1:* Address Line 1 is Required

Address Line 2: Address Line 2 is not valid

City:* City is Required

Country:* Country is Required

State/Province:* State/Province is Required

Zip/Postal Code:* Zip/Postal Code is Required

Full name:* Full name is Required

Preferred name:* Preferred name is Required

Medical Faculty of Colombo (MFC) year: eg 1992/93 Batch :* Medical Faculty of Colombo (MFC) year: eg 1992/93 Batch is Required

State of residence in Australia/ NZ:* State of residence in Australia/ NZ is Required

Current professional designation:* Current professional designation is Required

mobile:* mobile is Required

Emai:* Emai is Required

I declare that the information provided in this application is true and accurate to the best of my knowledge.*

Username:* Invalid Username

Email:* Invalid Email

Password:* Invalid Password

Password Confirmation:* Password Confirmation Doesn't Match

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Last modified: August 14, 2026

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