Registration for Life Membership
Please fill up and submit this form only after you have made a payment of the membership fee in the bank account of IAPC. This form will require the Transaction ID or Payment Reference No. of the payment you will be making.
Life Membership Fee Structure
Corporate bodies = Rs 50,000;
Palliative Care organisations = Rs 50,000;
Doctors = Rs 10,000;
Nurses = Rs 4,000;
Social Workers / Others = Rs 2,000;
Overseas candidates = $500.
Unpaid volunteers = Rs 2,000 (subject to certification by recognized institution in separate form to be send to us by post);
Cheques / DDs must be crossed and in favour of “Indian Association of Palliative Care”, and payable at:
State Bank of India,
Ansari Nagar East,
New Delhi – 110029, India.
Current Account No. 33808019294;
IFSC Code SBIN0001536;
MICR Code 110002005;
Branch Code 001536.
For payment related queries, please write to firstname.lastname@example.org
In the application form provided below, fill up each box with relevant data only.
Each applicant must insert his/her own genuine email address. This means that each member must have a unique email address by which he/she can be communicated by us.
In the ‘User Email‘ box, please insert only one email address. Do not insert multiple email addresses in it.
Likewise, insert only one mobile number in the ‘Mobile Number‘ box of ‘E. Contact‘ section. Do not insert multiple mobile numbers.
For the address parts in the form we have provided separate boxes for ‘City/Town/Village‘, ‘State/UT‘, ‘PIN‘ and ‘Country‘. So, please insert the details accordingly.
Those who are applying on behalf of an Organisation or Institution or any such body, must fill up the both ‘B. Personal‘ and ‘D. Organisation‘ sections.
Those who are representing only self, need to fill up the ‘B. Personal‘ section only.