Application for Membership

(Note: Before proceeding, please ensure that you have read the instructions given under "Instructions for filling the form". Please also ensure that the given information to be fed is readily available with you.)

* Mandatory Field
Full Name: *
Gender: *	Select Male Female
Qualifications: *
Medical council registration number:(for physician applicants):
Category of membership requested: *	Select Life Member Life Associate Member Annual Associate Member
Present designation: *
Complete address of Institute/ Hospital: *
Complete residential address: *
Contact Numbers: *
Office
Residence
Mobile number
Fax number
Email id: *
Whether a member of any other professional bodies: If yes,   please state the names of the academic organizations with the   membership number:

Educational Qualification Details (starting with graduation): *

Degree	College/ University	Year of passing	Awards/ distinctions/ honours
Select MBBS MD DM PhD DCH DGO OTHERS		Select 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008  2007  2006  2005  2004  2003  2002  2001  2000  1999  1998  1997  1996  1995  1994  1993  1992  1991  1990  1989  1988  1987  1986  1985  1984  1983  1982  1981  1980  1979  1978  1977  1976  1975  1974  1973  1972  1971  1970  1969  1968  1967  1966  1965  1964  1963  1962  1961  1960  1959  1958  1957  1956  1955  1954  1953  1952  1951  1950
Select MBBS MD DM PhD DCH DGO OTHERS		Select 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008  2007  2006  2005  2004  2003  2002  2001  2000  1999  1998  1997  1996  1995  1994  1993  1992  1991  1990  1989  1988  1987  1986  1985  1984  1983  1982  1981  1980  1979  1978  1977  1976  1975  1974  1973  1972  1971  1970  1969  1968  1967  1966  1965  1964  1963  1962  1961  1960  1959  1958  1957  1956  1955  1954  1953  1952  1951  1950
Select MBBS MD DM PhD DCH DGO OTHERS		Select 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008  2007  2006  2005  2004  2003  2002  2001  2000  1999  1998  1997  1996  1995  1994  1993  1992  1991  1990  1989  1988  1987  1986  1985  1984  1983  1982  1981  1980  1979  1978  1977  1976  1975  1974  1973  1972  1971  1970  1969  1968  1967  1966  1965  1964  1963  1962  1961  1960  1959  1958  1957  1956  1955  1954  1953  1952  1951  1950
Select MBBS MD DM PhD DCH DGO OTHERS		Select 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008  2007  2006  2005  2004  2003  2002  2001  2000  1999  1998  1997  1996  1995  1994  1993  1992  1991  1990  1989  1988  1987  1986  1985  1984  1983  1982  1981  1980  1979  1978  1977  1976  1975  1974  1973  1972  1971  1970  1969  1968  1967  1966  1965  1964  1963  1962  1961  1960  1959  1958  1957  1956  1955  1954  1953  1952  1951  1950
Select MBBS MD DM PhD DCH DGO OTHERS		Select 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008  2007  2006  2005  2004  2003  2002  2001  2000  1999  1998  1997  1996  1995  1994  1993  1992  1991  1990  1989  1988  1987  1986  1985  1984  1983  1982  1981  1980  1979  1978  1977  1976  1975  1974  1973  1972  1971  1970  1969  1968  1967  1966  1965  1964  1963  1962  1961  1960  1959  1958  1957  1956  1955  1954  1953  1952  1951  1950

Professional experience (in the chronologically descending order beginning with the current position): *

Designation	Hospital/ Institute	Duration	Special experience/ honours if any

ADD MORE

Additional academic achievements/ professional activities:
Areas of special interest:
List of publications (beginning with the most recent publication, list all publications in the last five years with the complete reference): *
Attach Necessary Documents: *
I hereby declare that the information I have provided in this application is correct to the best of my knowledge. I have read and understood the rules and regulations of the Indian Academy of Medical Genetics (IAMG). If granted membership of the IAMG, I agree to abide by the bylaws, procedures and regulations and I agree to disqualification from membership in the event that I violate any of the rules or regulations of the academy. I understand that the decision as to whether I qualify as a member of the IAMG rests solely and exclusively with the IAMG and that the decision of the IAMG is final. I agree with the above terms and conditions