Membership Sign Up

Please share the following information with us, and we will respond in 3-5 business days.

Note on Fees:

Entrance Fee: Tshs. 20,000 (one-time, except for Honorary Members)

Annual Subscription:

Payment details will be communicated upon approval of membership.

Name

First

Last

Date of Birth

Gender

Nationality

Contact Number

Email Address

Postal Address

Medical Registration Number

Medical Council

Current Employer / Institution

Job Title / Position

Specialty / Area of Practice

Years of Experience

Membership Category

Ordinary Member – Registered Obstetrician/Gynaecologist
Associate Member – Postgraduate Trainee / Clinician with interest in reproductive health
Honorary Member – Nominated for outstanding contribution (Council review required)

Highest Degree / Qualification

Medical / Experience

Institution / University

Year of Graduation

Professional Experience

Briefly describe your experience in obstetrics, gynaecology, or reproductive health.

Declaration

hereby declare that the information provided is accurate and complete. I agree to abide by the Constitution and By Laws of AGOTA if admitted as a member.