IACTS Membership ID Card – Form

Upload your picture*
Only passport size picture. No selfies, cropped and photoshopped pictures, please.
(requirements: high resolution, below 4 MB, with white background, in JPEG, GIF, PNG format)

Title (Mr./Ms./Dr./Prof.)*

Name (please provide full name)*

Qualification*

Designation*

Institution/Hospital/Clinic/Retired*

MemberType*

Membership Number

Click here to view - New membership number table      Know Your New Membership Number - Click here to view instructions

Address to be printed on the ID Card* (please provide only one complete address)

City*

Pincode*

State*

Country*

E-mail ID*:

Mobile. No.*

ISD + Mobile Number

Date of Birth*

Day:Month:Year:
Eg: Date Format: dd/mm/yyyy

Emergency Contact*

ISD + Mobile Number

Blood Group*

IACTS - Mail IconAddress where your membership ID card should be dispatched* (please provide only one complete address)

City*

Pincode*

State*

Country*

Sample ID cards:

IACTS - Associate Member Card

IACTS - Full Member Card
 

Registration for Existing Members

We request all existing members to Register with their details, since we are upgrading to a new website and would like to maintain a fresh database of all Members. After Registration, your membership will be verified and then activated. You will be given a Profile page where you can update your Professional and Personal details. You will also be eligible to participate in Forums and contact other Members through this website.

No Thanks, May be later