Join Mediversa Alliance for Healthcare Education and Advocacy

Full Name*

Email Address*

Phone Number (WhatsApp Recommended)*

Date of Birth*

City/Location*

Faculty/Department*

Degree*

Year of Study*

1st Year

2nd Year

3rd Year

4th Year/Final Year

5th Year/Final Year

Role Preferences*

Vice President

General Secretary

Treasurer

Media Head

Event Coordinator

Graphic Designer

Logistic Head

Content Writer

Community Member

Availability*

Weekdays only

Both weekdays and weekends

Why are you interested in this/these role(s)?*

Skills and Experience*

How Did You Hear About Us?*

Social Media (e.g., Facebook, Instagram)

Friend/Colleague

Event/Session

Website

Other

Consent and Agreement*

I agree to abide by the rules and guidelines set by MediVersa Alliance.

I confirm that all the information provided is accurate to the best of my knowledge.

I understand that I will be contacted by an MVA representative at my university for further steps, including an in-person interview at a time and place decided by the representative.

Join MVA-UOL Chapter

MediVersa Alliance