CCFP-YDM ANNUAL RENEWAL FORM Please enable JavaScript in your browser to complete this form.Caribbean College of Family PhysiciansYoung Doctors’ Movement (CCFP-YDM)Annual Renewal – Due January 1 Each YearSECTION 1 — MEMBER INFORMATION1. Full Name:2. Country:3. Email Address:4. Phone/WhatsApp:SECTION 2 — MEDICAL COUNCIL REGISTRATION 5. Medical Council Registration Number:(e.g., Jamaica, Barbados, Trinidad & Tobago, Guyana, OECS)6. Date of Initial Registration: 7. Expiry Date (if applicable):SECTION 3 — PROFESSIONAL STATUS(Select One)Student – US $50.00Intern – US $100.00Senior House Officer – US $100.00 Family Medicine ResidentEarly-Career Family Physician (≤5 years)Annual Renewal Fees: Student: US $50.00 Intern / Senior House Officer: US $100.00 Intern / Senior House Officer: US $100.008. Amount Paid:9. Payment Method:Online Payment PortalBank TransferDebit/Credit CardOther:10. Upload Proof of Payment: Click or drag a file to this area to upload. SECTION 5 — CCFP MEMBERSHIP STATUS11. Is your CCFP membership up to date?YesNoNot applicableSECTION 6 — AREAS OF CONTINUED INTERESTPlease select all areas you wish to remain involved in:LeadershipResearchTeachingDigital HealthPlanetary HealthWorking Parties/SIGsFM360 / ASPIREConference PlanningOutreach ProjectsSocial MediaMembershipOther:SECTION 7 — DECLARATIONI declare that the information provided is accurate and that I understand the annual renewalrequirements. Thank you for renewing your CCFP-YDM membership!Your continued involvement strengthens Family Medicine across the Caribbean.Submit
