AOP GUJARAT

TEST

AOPG MEMBER

BECOME A MEMBER – FOR PEDIATRICIANS ONLY
NOTE :
  • - If you are a CIAP MEMBER & have a permanent resident in Gujarat, you can become AOP Gujarat member by registering with the form below and paying Rs. 2,000/- life membership fee.
  • - Fill all the details as per records in CIAP for verification.
  • - Proposer & Seconder must be members of AOP Gujarat.
  • - 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 aopgujarat@gmail.com
REGISTRATION FORM
All fields marked with * are mandatory to enter
Allow only 10 digit
*
    Strength: Very Weak
    *
    * (ex - X/1234/X-1234) - USE ONLY CAPITAL LETTER
    *
    jpg, jpeg, png / Max 5 MB
    *
    (Upload Government Approved Documents)

    DETAILS OF PROPOSER (as per CIAP records)

    * (ex - X/1234/X-1234) - USE ONLY CAPITAL LETTER
    Allow only 10 digit

    DETAILS OF SECONDER (as per CIAP records)

    * (ex - X/1234/X-1234) - USE ONLY CAPITAL LETTER
    Allow only 10 digit
    Select Your Payment Gateway
    Razorpay
    How you want to pay?
    Payment Summary

    Your currently selected plan : , Plan Amount :
    Final Payable Amount:
    Scroll to Top