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American International Medical University 
Alumni Registration Form
STEP 1: Personal Information 
First Name*  Please enter your first name
Middle Name
Last Name*  Please enter your last name
Gender
Citizenship*
Year of Graduation*
Telephone Number*  Please enter your mobile number with Area Code
E-Mail Address*
Postal Address  Please Enter your Recent Communication Address
Step 2: Employment & Work Experience 
Are you Currently Employed?
Present Employer Name
Position
Work Location
Special Achievements after Graduation
Higher Education Details (If any) *
Higher Education Degree
If other Please Specify
Name of University & Country of Higher Education
Specialty (If Any)
Licensing exam
Year of Appearing Lic Exam?  Please enter the year for each exam appeared.
Do you hold License to practice?
Which Country Lic. do you hold?
If others (Please specify)  If you mentioned others in previous point please specify the country here.
Internship Hospital Name and Address  Please enter the name of Hospital, with address
Start year of Internship   Indicate the month and year you started internship.
End year of internship   Indicate the month and year you completed internship.