Online Registration

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'*' fields are mandatory

Any Queries Regarding Technical Assistance, Please Contact A1 Logics, 0824 – 4252005 (9:00 AM – 6:00 PM Working Days)

Basic Details

Name*
 
Gender*
 
Membership Type*
 
Contact Number*
 
Date of Birth*
 
Photo*
 
Email ID*
 
Password*
 
Confirm Password*
   
Address*
 
State*
 
Pincode*
 

Speciality

Select Specialty*
 

Certificate

Degree Certificate*
 

Proposed By/Seconded By

 
 
SAMPLE CONSENT LETTER

Proposer Membership Number*
 
Proposer Name* Proposer Name comes here
Consent Letter*
 
Seconder Membership Number*
 
Seconder Name* Seconder Name comes here
Consent Letter*
 
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