Online Membership Application Form Name User Name given by ADMIN Membership IDs Given by ADMIN Title * Mr Mrs Ms Miss Prof Dr Home Address * StateAndhra PradeshArunachal PradeshAssamBiharChhattisgarhDelhiGoaGujaratHaryanaHimachal PradeshJammu and KashmirJharkhandKarnatakaKeralaMadhya PradeshMaharashtraManipurMeghalayaMizoramNagalandOdishaPunjabRajasthanSikkimTamil NaduTelanganaTripuraUttar PradeshUttarakhandWest BengalAndaman and Nicobar IslandsChandigarhDadra and Nagar HaveliDaman and DiuLakshadweepPuducherry Membership Category * Life memberMember in Training Reference By * Personal Details * Degree * Year * Institution * University * Attachments : Current CV + Self attested photocopies of 1. MBBS 2. MD or equivalent 3. DM or equivalent degree certificate 4. State registration certificate of MBBS and additional qualifications 5. PAN card * Add Files Formats accepted: jpg, pdf Membership of other Associations/Societies The life time membership fee is INR 5000/- Do not add any payment at this time. The secretariat will contact you with a request for payment if you qualify for membership prior to credentialing.