Membership Form

Indian Psychiatric Society - Rajasthan Chapter

Membership Form

Prefix

Full Name in Block Letter

Date of Birth

Designation & Current Affiliation/Institute

Postal Address

Email ID

Contact Number

Qualifications (MBBS)

Professional Training (MD/DPM) if applicable

Professional Training (DM), if applicable

Proposed By

Seconded By

Additional Information (List Honours, Distinctions, Awards or any other Important Information)

Which Category of Membership are You Applying for?

Life Fellow

Life Ordinary Member

Life Associate Member

I Solemnly Affirm That :

I will uphold the aim and objectives of the Indian Psychiatric Society, Rajasthan Chapter to the best of my ability and agree to abide by its constitution and bye-laws which come to force time to time.

Fee Details :

Categories	Subscription Amount
Life Ordinary Member	2000
Life Fellow	3000
Life Ordinary Member To Life Fellow	1000
Life Associate Member	2500
Corporate Member	10000
Associate Member	1000

Bank Details for NEFT & IMPS:
For Name of Bank - ICICI Bank, Janta Colony, Jaipur Rajasthan | Account No - 675701140796 | Name - Indian Psychiatric Society | IFSC Code - ICIC0006757

Dr. Arvind Barad
Senior Consultant Psychiatrist
370/D1 3rd C Road Sardarpura, Jodhpur.
Cell: 9413439188
E-mail : drarvindbarad@gmail.com

IPS Membership Categories & Criteria : https://ipsraj.com/membership-rules/

Photo Upload :

IPS Life Fellow Membership Number

Highest Degree : (.doc)

Transaction Details : (.jpg / .png / .pdf)

ID Proof : (.jpg / .png / .doc)

Letter From HOD : (.doc)

Highest Degree : (.doc)

Transaction Details : (.jpg / .png)

ID Proof : (.jpg / .png / .doc)

Highest Degree : (.doc)

Transaction Details : (.jpg / .png)

Membership Form

Membership Form

Indian Psychiatric Society - Rajasthan Chapter

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