Lifetime Membership Form (All)
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Title
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Mr.
Ms.
Mrs.
Dr.
Vd.
Name
Relation (S/O D/O W/O)
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S/O
D/O
W/O
Father/Husband Name
Email
Create Password
Mobile
WhatsApp Number
Gender
Select your gender
Male
Female
Other
Date of Birth*
Day
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Year
Choose Your Speciality
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Private Practice
Government College Teacher
Private College Teacher
PG Student
Government Medical Officer
Private Medical Officer
Intern
Others (For Non-ayurvedic)
Specify Your Speciality
Permanent Address with Pin Code (Address to be printed on download certificate)
City
Permanent State
-- Select State --
Andaman and Nicobar Islands
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Dadra and Nagar Haveli and Daman and Diu
Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu and Kashmir
Jharkhand
Karnataka
Kerala
Ladakh
Lakshadweep
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Puducherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
International
Permanent District
-- Select a State First --
Pin / Zip Code
Present Clinic / Institute Address
Present Clinic / Institute Address is same as Permanent Address
Present State
-- Select State --
Andaman and Nicobar Islands
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Dadra and Nagar Haveli and Daman and Diu
Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu and Kashmir
Jharkhand
Karnataka
Kerala
Ladakh
Lakshadweep
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Puducherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
International
Present District
-- Select a State First --
Degree
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Graduation
PG
PhD
Qualification
Graduation
Post Graduation
-- Select Subject --
Agad Tantra
Ayurveda Samhita And Siddhant
Dravyaguna Vigyan
Kaumarbhritya
Kayachikitsa
Manas Roga
Panchkarma
Prasuti Tantra And Stree Roga
Rachana Sareera
Ras Shastra And Bhaishajya Kalpana
Rog Nidan And Vikriti Vigyan
Shareera Kriya
Shareera Rachana
Shalakya Tantra
Shalya Tantra
Swastha Vritta
Ph. D
If Any other
Online
Cash
Cheque
Attach a profile photo
(max size 5 MB)
File size must be less than 5 MB.
Reference*
(Please provide the name and contact number of any VAP member or Office bearers known to you.)
Reference Name
Reference Phone Number
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Membership Fee: Rs. 1100 only