IAPMR

Registration

Full Name *

Profile Image

Date of Birth

Email ID *

Mobile Number *
Landline Number
Address

Password *

Confirm Password *


# Qualification Year of Passing Institution
1 MBBS Degree
2 Diploma/MD/DNB degree
3 Other Qualification-Degree/Fellowship

Registration details with Medical Council of India/State Medical Council:

Medical Council Number

Registration Date

Council Name

IAPMR Life Membership Number


Documentation(*):

MBBS Degree *

Diploma/MD/DNB degree *

Other Qualification-Degree/Fellowship *


Declaration:

I here by certify that the statements filled by me in this application form are correct to the best of my knowledge. I agree to abide by the rules and by-laws of the IAPMR which have been read by me.