Apply for Membership

The following are eligible for membership in The Hamilton Academy of Medicine:

Legally qualified and registered medical practitioners in good standing in the Province of Ontario
Medical graduates of medical schools recognized by the CPSO who are engaged in teaching, research or medical administration in medicine or the allied health sciences, in the Province of Ontario
Medical graduates of medical schools recognized by the CPSO who are medical officers of the Canadian Forces or civil or public health service while assigned to duty in the Province of Ontario
Individuals who are currently enrolled in a medical school or a residency program in the Province of Ontario

Personal Information

First Name

Last Name

DOB

Gender

Home Address

City

Province

Postal Code

Home Phone

Home Fax

Professional Information

CPSO

CPSO Year

Medical School

Grad Year

Degrees

Hospital

Hospital Privileges

Yes No

Practice Information

Type of Practice

Wait Time

Wheelchair Accessible

Yes No

Office Address

City

Province

Postal Code

Office Phone

Private Line

Office Fax

Preferred Mailing Address

Home Office

Practice Limited to

Clinic Special Interests

Languages Spoken

Optional Information

Spousal Status

Place of Birth

Name of Spouse

Number of Children and/or Names