Membership form

Eligibility for life membership:
The life membership of the Association shall be confined to those who have or pursuing postgraduate Medical qualification (MD/MS) in any of the following disciplines:
Anatomy, Physiology, Biochemistry, Pharmacology, Microbiology, Pathology, PSM and Forensic Medicine.

Note: Ensure pay membership fee 5000/- in acc no. 37342796010 ifsc SBIN0032405. Or UPI Id aipcma@sbi For detailed instructions click here
After paying fee take screenshot then fill and submit online form below
Upload recent Passport size Photo (jpg/png<500kb), registration certificate (pdf/jpg/png < 2mb) and screenshot of transaction.

For UPI Payment scan QRCode:

Name*

Gender*

Age*

Date of Birth*

Present Position*

I am HOD also

Institute*

Permanent Address*

State*

Correspondence Address (if different)

Academics

Education*

Subject*

Medical Council*

Registration No.*

Upload Certificate*(pdf/jpg upto 2mb)

Contact Information:

telephone number:

Mobile*

E-mail*

Upload passport sized Photo*

Transaction details

Amount*

Name of Bank*

Upload Transaction screenshot*

Transaction ID / DD ID / Cheque No.*

Date*

All the information given herewith by me is true to the best of my knowledge and in case of any discrepancies I will be liable to actions as per rules of association. I acknowledge that the lifetime membership fee of AIPCMA is non-refundable under any circumstances. I will abide by the rules and regulations of AIPCMA.

Instructions for online submission:

Make payments (plus donation, if willing).
Fill the form above
Upload recent Passport size Photo (jpg/png<500kb) and registration certificate (pdf/jpg/png < 2mb).
And submit

Note: to Be added in life member whatsapps group, whatsapp to +919460869669

Membership form

Note: to Be added in life member whatsapps group, whatsapp to +919460869669