APDIM International Residency Program New Member Enrollment Form

FY 2023 (July 1, 2022–June 30, 2023)

Internal medicine residency programs located outside the United States and Canada are invited to join APDIM. APDIM international program dues are $2,730 per year and include the residency program director and any additional faculty and staff involved in the internal medicine residency program. All new applications must be reviewed and approved by the APDIM Council before membership is granted.

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Residency Program Information

Email address of person completing this form *

Program Name *

Medical School Affiliation(s) (if applicable)

Program Email Address *

Address 1 *

Address 2

City *

Country *

Zip/Postal Code *

Telephone *

Fax

Residency Program Director Information

Program Director name *

Suffix 1 *

Suffix 2

Gender

Program Director Email *

Address 1 *

Address 2

City *

Country *

Zip/Postal Code *

Telephone *

Fax

Additional Residency Program Information

Program Website

Does your country have an organization which accredits residency programs? *

Yes

No

If No, please upload an outline of your Internal Medicine Residency curriculum.

If yes, what is the name of the organization?

If yes, is your internal medicine residency program accredited by this organization?

Yes

No

N/A

If your program is not accredited by this organization, explain why:

0/300 words

If an accrediting organization exists, please provide a copy of the internal medicine residency program requirements with your application.

Internal Medicine Residency Requirements as per accrediting body.

In addition to internal medicine, what other graduate medical education programs are offered at your institution?

Is there subspecialty internal medicine training at your institution?

Yes

No

What is the length of internal medicine training for residents in your program?

How many residents does your program enroll per year?

How many faculty are involved in the internal medicine residency program?

Application Process

Your application will be submitted for review. Once reviewed, your program will be contacted regarding the status of your application. If approved, please submit payment, as instructed below. After payment is received, your program may enroll members. If you have questions about the application process, please email memberservices@im.org or call (703) 341-4540.

Member Enrollment

Once approved, your program may enroll members online at www.im.org/join. In addition to the program director, please enroll all faculty and staff involved in the internal medicine residency program.

Payment Information

The dues amount for APDIM International membership is $2,730. Dues payment covers the program director and all program representatives. Membership dues payment may be made by check or by credit card. Payments by check must be drawn on a US bank in US dollars. Please make checks payable to AAIM and mail to:

AAIM

PO Box 222181

Chantilly, VA 20153-2181

(AAIM's Tax ID number is 27-3063631)

If paying by credit card, please call AAIM Member Services at (703) 341-4540.