MEMBERSHIP FORM
* Name
* Qualifications (degree / diploma)
* Present position, designation, specialty if any
* Date of birth (DDMMYYYY)
Date of marriage (if married)
* Address
* City
* Zip/Postal Code
Country

* Phone (Res) (including ISD/STD code)
* Phone (Off) (including ISD/STD code)
Fax
* E-mail
Website, if any
Year of passing (UG ie. MBBS)
* Qualification(s) achieved at IPGMER & year thereof
* Medical registration number & name of council
* Type of membership applied for
FEES DETAILS
* Cash / Cheque No
* Dated
* Drawn on Bank (Branch)
* Amount Rs.
         
The Alumni
The Alumni Mission Statement Governing Body Membership Details Members' Directory Past Events Ensuing Events Query Contact Download Membership Form Newsletter IPGMER Home Download Membership Form