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₹
500.00
Email
(Required)
Designation/Title
(Required)
Prof.
Dr.
Mr.
Ms.
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Full Name (as per official records)
(Required)
Date of Birth
(Required)
DD slash MM slash YYYY
Mobile Number
(Required)
Annual Membership Number (AM-.....)
(Required)
Proof of Annual Membership
(Required)
(Attach any document/certificate/slip issued by the IHC to attest your membership)
Accepted file types: jpg, jpeg, pdf, Max. file size: 5 MB.
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