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);

Bank Details

Cheques / DDs must be crossed and in favour of “Indian Association of Palliative Care”, and payable at:

State Bank of India,
AIIMS Campus,
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 nioiapc@gmail.com

Application Instructions

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.

Application Form for Life Membership

A. Membership
Indian
Overseas
Individual
Organization
B. Personal
Dr.
Mr.
Mrs.
Miss
C. Professional
D. Organization

This section is only for those who are applying on behalf of an organization

This section has to be filled by only those applicants who are representing an organization.

E. Contact
G. Misc
Cash
Cheque
DD
Online transfer

Please provide the Transaction ID or Payment Reference Number for the payment of fee in the box below.

In addition to the Payment Reference Number, you may also upload a digital copy ot the transaction document below.