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: *    
  Qualifications: *   
  Medical council registration number:(for physician applicants):   
  Category of membership requested: *   
  Present designation: *   
  Complete address of Institute/ Hospital: *   
  Complete residential address: *   
  Contact Numbers: *  
      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
  Professional experience (in the chronologically descending order beginning with the current position): *
Designation Hospital/ Institute Duration Special experience/ honours if any
  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