TEST

BECOME A MEMBER – FOR PEDIATRICIANS ONLY

NOTE :

- If you are a CIAP MEMBER & have a permanent resident in Gujarat, you can become AOP Ahmedabad member by registering with the form below and paying Rs. 1,000/- life membership fee.
- Fill all the details as per records in CIAP for verification.
- Once your details are verified, your account will be activated. After that, you will able to log in to your account.
- For any query you can contact us on aopahmedabad@gmail.com

REGISTRATION FORM

All fields marked with * are mandatory to enter

* Mobile Number (Username)

Allow only 10 digit

* Surname

* Name

Gender

Male

Female

* Date of Birth

* Email Address

* Confirm Email Address

* Password

Strength: Very Weak

* Hospital Address

* Residential Address

* State

* City

* Pincode

* CIAP Number

Profile Picture

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jpg, jpeg, png / Max 5 MB

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