BECOME A MEMBER – FOR PEDIATRICIANS ONLY

If 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)
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Only Numbers are Allowed
Please enter at least 10 characters.
Maximum 10 characters allowed.
Only Numbers are Allowed
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This Mobile Number (Username) is invalid. Please enter a valid Mobile Number (Username)..
*
Surname
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Only Alphabets are Allowed
Only Alphabets are Allowed
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*
Name
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Only Alphabets are Allowed
Only Alphabets are Allowed
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Do not enter prefix Dr.
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Email Address
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Confirm Email Address
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*
Password
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Please enter at least 6 characters.
    Strength: Very Weak
    Qualification
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    *
    Hospital Address
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    *
    City
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    Only Alphabets are Allowed
    Only Alphabets are Allowed
    *
    Pincode
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    Please enter at least 6 characters.
    Maximum 6 characters allowed.
    Only Numbers are Allowed
    Postal Address
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    CIAP Membership No.
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    *
    Profile Picture
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