Note: Once the Associate Member having obtained full board certification and upgrading to full membership, you can send an email to SLCIM with the board certification document. The membership will be upgraded to life membership with no additional payment provided that you have already paid Rs: 5000/- when getting the associate membership. (This affects from 2024 onwards)

    Basic Infromation

    Applicant’s Full name:

    Surname with initials:

    Address (Residence):

    Hospital/Faculty:

    Telephone:*



    Email:

    Date of Birth:

    Civil Status:

    Gender:

    Qualification

    MBBS qualified year:

    SLMC Registration Number:

    MD qualified year:

    What are your special interests:

    Additional professional courses you have followed and completed:

    Documentary evidence of PGIM letter and/or MD certificate:




    Membership

    Associate membership fee - Rs 5000/=

    Account number – 1730032500 Commercial Bank, Peradeniya.
    Account name – SRI LANKA COLLEGE OF INTERNAL MEDICINE

    Upload payment receipt (image/pdf):

    Name 2 referees having collage membership:

    By clicking "yes", I certify that I hold a current active medical license and I shall not misuse my membership status In SLCIM regulations. I declare that particulars given above are accurate.