AOPG MEMBERSHIP FEESLife Membership₹2,000.00Annual Membership₹1,500.00BECOME A MEMBER – FOR PEDIATRICIANS ONLYIf you are a pediatrician, you can become Academy of Pediatrics Gujarat member by registering with the below form. Membership Fees : Annual Membership Rs. 1500/- and Life Membership Rs. 2000/-. You will NOT be able to login without verification and payment. Registration Form All fields marked with * are mandatory to enter*Mobile Number (Username)Mobile Number (Username) can not be left blankOnly Numbers are AllowedPlease enter at least 10 characters.Maximum 10 characters allowed.Only Numbers are AllowedThis username is already registered, please choose another one.This Mobile Number (Username) is invalid. Please enter a valid Mobile Number (Username)..*SurnameSurname can not be left blank.Only Alphabets are AllowedOnly Alphabets are AllowedThis Surname is invalid. Please enter a valid Surname.*Name * Do not enter prefix Dr.Name can not be left blank.Only Alphabets are AllowedOnly Alphabets are AllowedThis Name is invalid. Please enter a valid Name.Do not enter prefix Dr.*Email AddressEmail Address can not be left blank.Please enter valid email address.Please enter valid email address.This email is already registered, please choose another one.*Confirm Email AddressConfirm Email Address can not be left blank.Please enter email address again.Please enter email address again. Please enter email address again.*PasswordPassword can not be left blank.Please enter valid data.Please enter at least 6 characters.Strength: Very WeakQualificationQualification can not be left blank.Please enter valid data.*Hospital AddressHospital Address can not be left blank.Please enter valid data.*CityCity can not be left blank.Only Alphabets are AllowedOnly Alphabets are Allowed*PincodePincode can not be left blank.Only Numbers are AllowedPlease enter at least 6 characters.Maximum 6 characters allowed.Only Numbers are AllowedPostal AddressPostal Address can not be left blank.Please enter valid data.CIAP Membership No.CIAP Membership No. can not be left blank.Please enter valid data.*Profile Picture * Drop file here or click to select.Drop file here or click to select.Please select file.Invalid file selected.Invalid file selected.Allowed File Size : Only 1 MBcropSkip(Use Cropper to set image and use mouse scroller for zoom image.) Select Your Payment GatewayRazorpayHow you want to pay? Auto Debit Payment Manual PaymentPayment SummaryYour currently selected plan : , Plan Amount : Coupon Discount Amount : , Final Payable Amount: Submit