Register

Full Name:
Gender : MaleFemale
Date of Birth :
Qualification and Year of Passing :
Medical Council Registration number :
Mailing Address :
Permanent Address :
Email address :
Mobile number :

Attachments

a. Photograph :
b. Proof of Medical Council Registration :
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Payment details

Annual membership fees – Rs. 2000
Please transfer the above amount to the following bank account:
A/c name – Association of Emergency Physicians of India
A/c number – 016694600000673
IFSC code – YESB0000166
Reference – Your name
Once the transfer has been made, you will receive a confirmation from us within 14 days.

I agree to transfer the membership fee and I do understand this fee is non-refundable and willing to abide by the rules and regulations as per the memorandum of the association if accepted as a member.

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