Register

Membership Plan

*
Username
Username can not be left blank.
Please enter valid data.
This username is already registered, please choose another one.
This username is invalid. Please enter a valid username.
*
Email Address (For all future communication)
Email 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.
*
Password
Password can not be left blank.
Please enter valid data.
Please enter at least 6 characters.
    Strength: Very Weak
    Profile Details
    *
    Title
    Text field can not be left blank.
    Please enter valid data.
    *
    First Name
    First Name can not be left blank.
    Please enter valid data.
    This first name is invalid. Please enter a valid first name.
    *
    Last Name
    Last Name can not be left blank.
    Please enter valid data.
    This last name is invalid. Please enter a valid last name.
    *
    Gender
    MaleFemale
    Please select one.
    Please enter valid data.
    Educational Qualification (MBBS / Indian System of Medicine / Dentistry (BDS) / Engineering (BE) / Nursing (B.Sc. Nursing)/ Veterinary (BV Sc. & AH) / MSW, M. Stat etc / DHE / Dip Diet / DPHN degree MD PSM / Community Medicine).
    Please fill your educational qualification
    Please enter valid data.
    Educational Qualification (Upload only PDF File Max Size 2 Mb)
    Please select file.
    Invalid file selected.
    Invalid file selected.
    Present Designation
    Text field can not be left blank.
    Please enter valid data.
    *
    Date of Birth
    Please fill your Date of Birth.
    Invalid Date.
    Mailing Address
    This Field can not be left blank.
    Please enter valid data.
    City
    Text field can not be left blank.
    Please enter valid data.
    State
    Text field can not be left blank.
    Please enter valid data.
    Pin Code
    Text field can not be left blank.
    Please enter valid data.
    *
    Country/Region
    Country/RegionAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongoCosta RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceFrench GuianaFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayNorthern Mariana IslandsOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe
    Please select atleast one option.
    Please enter valid data.
    *
    Mobile Number
    Text field can not be left blank.
    Please enter valid data.
    Field of Specialization
    Community MedicineHealth EducationPublic Health EngineeringPublic Health AdministrationPublic HealthSociologyVeterinary Public HealthBio-StatisticsMCH & FWPublic Health NurshingNutrition & DieteticsOthers
    Please select atleast one option.
    Please enter valid data.
    No of Publication in Indexed Journal
    Text field can not be left blank.
    Please enter valid data.
    Membership of other Professional Association
    Text field can not be left blank.
    Please enter valid data.
    Branch Affiliation, if any
    Text field can not be left blank.
    Please enter valid data.
    Select Your Payment Gateway

    Bank Details for NEFT


    AC Name: Indian Public Health Association


    Bank: United Bank of India


    Branch Name: Medical College Hospital


    Branch code: 0835


    Savings Account No: 0835010106231


    MICR Code: 700027092


    IFSC Code: UTBIOMCHA13
    Transaction ID
    Please enter Transaction ID.
    Bank Name
    Please enter Bank Name.
    Account Holder Name
    Please enter Account Holder Name.
    Additional Info/Note
    Please enter Additional Info/Note.
    How you want to pay?
    Payment Summary

    Your currently selected plan : , Plan Amount :
    Final Payable Amount:
    Submit