Membership registration

Membership Form

1. Personal information

Name:                                                                                               

Affiliation:

Mailing address with PIN code:  

Permanent address:

Phone: +91

E-mail address:

Educational qualifications:

Aadhar card no.: 

Major field of professional expertise:     

2. Membership applied for (add ‘YES’ for your choice):

-   Life Membership, Rs 4500:

-   Student Annual Membership, Rs 750:

3. How to make payment of the fee: Pay by QR Code and insert your full name in the box ‘Add a note” while making the UPI payment. 

4. How to submit the application form:

-   E-mail a scanned copy or a high-quality photo of the duly signed Membership form to secretary@aphe.org.in

-   Attach a screenshot of the UPI transaction or insert in the form below.

-   Insert your high-quality passport size photo or send it as an email attachment.

Signature:                                    Place:          Date:      /      /

 [Insert your photo here]

 [insert payment receipt here or send as an email attachment]