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;
Counsellors / Social workers / Physiotherapists /
  Pharmacists / 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

The membership fee is to be either transferred online, or deposited into the IAPC’s account. The details of the IAPC’s bank account, to which the transfer is to be made, is as follows:

Bank name: State Bank of India
Branch name: Giridharnagar
Bank Address: State Bank of India, Near BSNL Office, Near Nilkanth Park 1, Ghoda Camp Road, Shahibaugh, Ahmedabad – 380004, Gujarat.

Account name: Indian Association of Palliative Care
Account number: 33808019294
IFSC Code: SBIN0003791
Branch code: 03791

UPI ID: IAPC399@SBI

Please also note: You are requested to upload online or offline receipt of payment made while submitting the online membership application form below.

For payment related queries, please write to the Accountant, IAPC (iapcmembership@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 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
B. Personal
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.

Please select 'Not Applicable' from below if it is an overseas location.

E. Contact

Please select 'Not Applicable' from below if you are an overseas applicant. If you are an Indian applicant, select your State/UT.

G. Misc

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. Please note that only jpg, jpeg, gif, png and pdf files are allowed. The size of file should not exceed 4 MB.