1

PROFILE

2

FAMILY INFORMATION

3

QUALIFICATION

4

CONTACT

5

MEMBERSHIP

Profile Information

(Hint: First Name : "Your Name", Middle Name / Last Name could be your village Name/Family name/Father's name, as per your practice)
(+91)

Family Info

Name Date of Birth Relationship

Education Qualification

Details of Education

Degree/Certificate Institute University/Board Year of Passing

Contact Information

(+91)
(+91)
(+91)

Membership Detail

Registration Fee : 400.00

I Dr. solemnly declare that the information given above is true to the best of my knowledge and belief. Kindly enroll me as a member of Indian Homoeopathic Medical Association and if enrolled as requested, I shall remit all the dues as may be prescribed from time to time and will obey the rules and regulations of the association as are enforced or amended from time to time. I also solemnly declare that I will always upkeep the dignity and integrity of medical profession in general and homoeopathic system in particular.

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