AKUAANA Member Registration Form

Become a member of AKUAANA today!

Becoming an AKUAANA member is one of the simplest, yet most meaningful ways for AKU Medical College alumni in North America to stay connected with AKU, as well as demonstrate their pride in being part of the AKU Alumni Association.

Exclusive Network

Opportunities for networking, mentorship, and career development.

Lifelong relationships

Build lifelong connections that benefit your personal and professional journeys.

Registration Form

Please fill up the form below to create your account.

Personal & Contact

Address & Professional

Please correct the errors below.

First Name *

Last Name *

Full Name (as per AKU records) *

Email *

Confirm Email *

Cell Phone *

Class of *

Student ID (M number)

Date since residence in North America *

Street Address *

Address Line 2

Country *

State / Province *

City *

ZIP / Postal Code *

Specialty *

Institution of Current Employment

Designation / Job Title

Would you be interested in volunteering for any of the following AKUAANA committees?

Elective and Mentorship Committee Awards Committee Regional Host Committee

Are you registered as an APPNA Member? *

Yes No

What type of APPNA Membership do you have? *

Please enter your APPNA Member ID below:

Create Password *

Confirm Password *

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