Administration Page:

Adding, removing, or changing your Aeromed-List membership address

and / or

Adding, removing, or changing your details on the practitioners pages
Please do read the information on the aeromed-list FAQ page (Frequently Asked Questions). Your knowledge of this information will prevent you having to bother the listowner for trivial problems that you should be able to manage yourself ...... the list owner gets very grumpy when folk hassle him with problems that are well covered in this FAQ.

Please do check that you type in your email address correctly.
Aeromed-List & Aeromedical Practitioner Webpage.

Please fill in the information below and then click on the 'submit' button at the bottom of this form.

The fields marked * are essential for your application to be processed.

* I would like to:

Join
Join the aeromed-list;
Be added to the aeromedical practitioners webpages;
Leave
Leave the aeromed-list;
Be removed from the aeromedical practitioners webpages;
Change
Change my aeromed-list address;
Update my information on the aeromedical practitioners webpages.
   
Check one or more of the options listed above.
My name is:

* *
The part of my name to be used for indexing my entry is:

* *

For example: If you enter "Smith" in this box your website entry will be indexed under "S", "d'Angelo" will be indexed under "D", "Angelo" will be indexed under "A", "van Dalen" will be indexed under "V", "Dalen" will be indexed under "D", "Al Yusuf" will be indexed under "A", and "Yusuf" will be indexed under "Y" (etc).
My email address is:

* *

Your full e-mail address as it appears in the 'from' header of e-mail that you send.

The old email address that I'd like removed is:

If you're using this form to change addresses. This address will be removed from the aeromed-list.
My contact telephone number:

* *

Include the country code (e.g +61 for Australia or +1for the USA & Canada etc) but not the prefix you use to make international calls (e.g. 0011 or 011 etc). (e.g. +61 [8] 8393-3158 or +1 [757] 593-5652). For identity validation purposes only - will not be placed on website entry.
My country of domecile:

* *

The first section of this menu contains the countries with most members on the list. The second section, after the divider, contains a complete country listing in alphabetical order. The last entry is 'other' in case your country has been missed.
My date of birth:
Birth Day: Birth Month: Birth Year:
19
My gender:
Comments for inclusion in my entry on the practitioners webpage:

Please include the descriptive information you'd like included on the Aviation Medicine Practitioners pages. Your name, e-mail address, and country will be automatically added to your entry. Include any contact details (such as addresses and telephone numbers) that you'd like publicised in this entry.

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