Member Registration – theassociationofshalaki

Registration

THE ASSOCIATION OF SHALAKI (T A S - INDIA) MEMBERSHIP APPLICATION FORM

* First Name

Middle Name

* Last Name

Designation

Speciality

Website Address

Address: Residence (Permanent):

Temporary Address:

Address of Working place:

* Whatsapp Mobile Number +91

Mobile Number

* Email

* Username

* Password

* Confirm Password

Date of Birth

Date of Marriage

* State Council Registration Number

* State chapter

Academic Qualification

BAMS

* University

* Month & Year of Passing

M. S. / M. D. Shalakyatantra

University

Month & Year of Passing

Ph. D

University

Month & Year of Passing

PG Scholar

College/University

Bonafide letter of College

Upload

Please attach attested copies of certificates

* Passing certificate BAMS

Upload

Passing certificate MD/MS Shakakyatantra

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* Registration Certificate of State Council (Provisional/Permanent)

Upload

Additional Qualification Certificate

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Profile Photo

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Registration

THE ASSOCIATION OF SHALAKI (T A S - INDIA) MEMBERSHIP APPLICATION FORM

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