Title * Select Dr. Prof. Mr. Mrs. Ms.

Full Name *

Photo *

Email *

Mobile (WhatsApp Number) *

Designation *

Affiliation / Institution *

IAMM Membership *

IAMM Membership Number *

State Medical Council No. / MCI Reg. No. *

Institution Address *

Residential Address *

Town / City *

State *

Postcode / Zip *

Food Preference

Accommodation Needed

Registration Category * Select Category IAMM Member (Life Member/Associate Member) Non-IAMM Member Non-IAMM Member (PhD and Post-PhD candidate) Post Graduate Students Accompanying person with Banquet Exemption From Registration Fees (Above 65 Year of age only Life members) Exemption From Registration Fees President and all Executive Committee members of IAMM Exemption From Registration Fees Winners of all four IAMM Awards Exemption From Registration Fees Past Presidents of IAMM and their Spouse. Exemption From Registration Fees IAMM and Student Symposium moderators and participants

Upload Aadhar Card * Upload Aadhar card image or PDF.

Upload HOD Letter * Upload signed HOD letter / Institute (PDF/Image).

Registration Amount *