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Application for the Final Written Examination for the Fellowship of


The College of Anaesthetists of Ireland (F.C.A.I)
Day

Month

Date of Intended Exam:

Year
College ID:

Surname
First name
Day

Month

Year

Date of Birth

Gender

Nationality

Email
Correspondence Address

Mobile or Telephone

Name of body with whom you


obtained medical registration e.g
Irish Medical Council

Registration Number

Primary Medical Qualification


Year
Country where qualification was awarded
Please list any attempts at the Final FRCA of the RCOA below
1.

3.

5.

2.

4.

6.

I passed the CAI Primary /Membership examination on:


or the
following exempting qualification from the current examination regulations.
Please tick
The Primary or Final Fellowship of the Royal College of Anaesthetists (UK)
The Fellowship of the Australian and New Zealand College of Anaesthetists
The Fellowship of the College of Anaesthetists of South Africa
The Fellowship in Anaesthesia of the Royal College of Physicians and
Surgeons of Canada
The Diplomate Certificate of the American Board of Anesthesiology
The Diploma in Anaesthesiology of the European Society of Anaesthesiology
The Fellowship in Anaesthesiology of the College of Physicians and Surgeons
Pakistan since April 1998
Overseas Qualifying Examination of the College of Anaesthetists of Ireland

Please attach photocopies of exempting qualifications signed as


true copies by the consultant that signs the application form.
Are you in a training programme? Yes
No
Please name the body
responsible for the programme and the grade or title of the post. e.g CAI SAT
4
Employment History: Please list 36 months of employment in
anaesthetic posts in chronological order starting with your current
post.
Grade or title of
post

Hospital Name (Country)

Signature of Exam Candidate

From (date)

To (date)

Signature of Head of Department


Print Name of Head of Department
Date

Hospital

PAYMENT DETAILS FINAL FELLOWSHIP

COLLEGE ID

Candidates Full Name

Cheque, bank draft or money order attached

OR

credit card

(Payable to CAI)

CREDIT CARD NUMBER


MASTERCARD

VISA

EXPIRY

VISA DEBIT
-

MM/YY

Security code

Amount 600
Name on card (block letters)
Cardholders signature
Send the completed form together with the full amount of the fee to:
College of Anaesthetists of Ireland
Examinations Department
22 Merrion Square North
Dublin 2
Ireland
Email: exams@coa.ie

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