Membership Application
Your Photo
(Optional)
Type Membership
*
Active
(UAE Nationals only)
Honorary
(UAE Nationals only)
Associated
Full Name
*
Nationality
*
UAE ID Number
*
Gender
*
Male
Female
Date of Birth
*
Are You
*
Patient Of Rare Disease
Patient Family
Volunteer
Attach documents
*
Passport
EID
Visa
(For Associated)
Qualification
*
Profession
*
Employer
*
Job Title
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Mobile Phone
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Email
*
P.O. BOX - Emirate
(Optional)
Terms and Conditions
*
Submit