• Name*
  First Name Last Name
• Date of Birth*
• Nationality*
• Current Country of Practice*
• Title of Clinical Cardiology Higher Certificate*
• Year Higher Certificate was Obtained*
  Please note that the higher certificate in cardiology must be three years or older.
• Mobile Number*
• Email*
• File*
  Max. file size: 10 MB.
  Please attach a certificate from the local GCC cardiac society indicating that you are recognized in the country as a Cardiologist practicing independently at the level of consultant.
• File*
  Max. file size: 10 MB.
  Please provide a letter from the local GCC cardiac society indicating you have paid the dues of $50 or its equivalent.