Join Our Association with a Membership Fee of ₹3,500 – This Fee Is Applicable Only Once Your Application Has Been Evaluated and You Are Found Eligible for Membership. Recent photo Photo (Max 4MB) * Upload recent passport-style photo. jpg/png only. Photo Remove Upload Member Details Salutation * Dr. Mr. Ms. Mrs. First Name * Middle Name Last Name Gender * Male Female Date of Birth Date of Marriage Email Address * All communication will be done on this email address. Mobile No. * (10 digits) All communication will be done on this number. Telephone no. (With STD CODE): Office Mobile number 2 (WhatsApp only) Qualification with Year * Please include degree and year in parentheses, e.g. MSc (2022), BTech (2023). Degree Certificate(s)* (Upload degree certificates — up to 3 files — max 4MB each) (Allowed: pdf, doc, docx, jpeg, jpg, png, gif, bmp) File 1* File 2 File 3 Current Designation Select Designation Community Physician Dietician Doctor Eminent Scientist Epidemiologist Health Administrator Microbiologist Nursing Nutritionist Program Manager Public Health Research Scientist Scientist Student Teacher / Faculty Current Institution * Current Work Location (State & place) Mention state and place. Experience Certificate * (Upload experience certificate — max 4MB) (Allowed extensions: pdf, doc, docx, jpeg, jpg, png, gif, bmp) Upload Id Proof ID Proof* (Passport, Aadhar card, Election Card or Driving License or Employer Identity Card. Any one of these - max 4MB) (Allowed extensions: pdf, doc, docx, jpeg, jpg, png, gif, bmp) Areas of Professional Interest Choose one of the following... Epidemiology Public Health Diabetes Cardiovascular Disease Chronic Respiratory Diseases Cancers Stroke Chronic Kidney Diseases Mental Health Health Promotion Biostatistics Quantitative Epidemiology Other Please specify Membership of other Association Awards / Fellowship at National Level Expectations from the Association Correspondence Details Address Line 1 * Country * Select Country India State / UT * Select State / UT Andaman and Nicobar Islands Andhra Pradesh Arunachal Pradesh Assam Bihar Chandigarh Chhattisgarh Dadra and Nagar Haveli and Daman and Diu Delhi Goa Gujarat Haryana Himachal Pradesh Jammu and Kashmir Jharkhand Karnataka Kerala Ladakh Lakshadweep Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Odisha Puducherry Punjab Rajasthan Sikkim Tamil Nadu Telangana Tripura Uttar Pradesh Uttarakhand West Bengal City Pincode * District * Select district I agree to terms and conditions and certify information is true. Submit Application
