Student Application form

Instructions

Students pursuing or holding a healthcare degree, including pre-med, medical, dental, or other health-related fields, must be Syrians or of Syrian descent and enrolled in or graduates from accredited institutions in the United States or Canada.

Select An Option

Student $50 Annually

Enter Contact Information

Prefix (i.e. Mr. Mrs. Dr.)

First Name

Last Name

Suffix (i.e Jr. Sr. III)

Designations

E-mail

Family NameBusiness Name

Please select a valid membership option and fee item if exist

Student Application form

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