INDIAN ACADEMY OF MEDICAL GENETICS
(Administered by society registered under the Societies Act XXI of 1860)
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
Prefer not to say
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
MSc
BSc
OTHERS
Select
2024
2023
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
MSc
BSc
OTHERS
Select
2024
2023
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
MSc
BSc
OTHERS
Select
2024
2023
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
MSc
BSc
OTHERS
Select
2024
2023
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
MSc
BSc
OTHERS
Select
2024
2023
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