Note: Once the Associate Member having obtained full board certification sends an email to SLCIM with the board certification document, the membership will be upgraded to life membership with no additional payment.

    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:

    Borad Certification year:

    Documentary evidence of MD certificate/ board certification certificate:




    Membership

    Select Membership type

    Life Membership

    Life Membership Criteria: MD in Medicine awarded by PGIM, University of Colombo, Sri Lanka AND having full board certification as a Specialist in Internal / General Medicine.

    Associate Membership

    Associate Membership Criteria: MD in Medicine awarded by PGIM, University of Colombo, Sri Lanka AND practicing as a Senior Registrar / Acting Consultant in Internal/General Medicine.

    Life membership fee - Rs 5000/=

    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.