Dubai Dx | Membership Registration

— Membership & Application Type

Membership category *

Corporate Individual

Application type *

New Renewal Update details

Existing membership number (renewal / update only)

01 Organisation Details · corporate applications only

Legal registered name

Primary diagnostic activity

Organisation type

Trade licence / registration no.

Licensing authority & expiry

Company website

Emirate and business address

Corporate applicants: attach a valid trade licence. Other facility permits may be requested for eligibility review.

02 Applicant / Primary Representative

Full name *

Job title / professional designation *

Work email *

Mobile / WhatsApp (with country code) *

Employer / organisation (individual applicants)

Professional specialty / discipline

Professional category (individual)

Professional licence & authority (if applicable)

03 Additional Corporate Nominees · optional

The primary representative above counts as nominee 1 of 5. List up to four additional nominees below.

#	Full name	Designation / department	Work email
2
3
4
5

04 Areas of Interest · select any

Other areas of interest

Priority industry issue for the Group to address

05 Communication, Consent & Declaration

Confirm the declarations below. Optional communication and directory consents may be withdrawn by contacting the Group.

I confirm the information supplied is accurate and complete. * For corporate membership, I am authorised to apply on behalf of the organisation. * I understand that submitting this form does not grant membership; approval, fees, benefits and any voting rights are governed by the Group's approved rules and Articles of Association. * I would like to receive event and activity updates by email. I consent to being added to the member WhatsApp group (my name and number may be visible to other members). I consent to listing my / the organisation's details in the member directory.

Authorised signatory name *

Designation *

Date *

Submit to wailsamawi@dubaidx.org. Membership enquiries: Wail Samawi · +971 50 297 7756. “Submit by Email” opens your email client with the completed details; documents (trade licence, company profile) should be attached manually. Submitting this form does not grant membership.