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IHSC Membership Registration Form
Please fill this form to apply for an individual membership
1. Personal Information
First Name *
Last Name *
Email Address *
Password *
Date of Birth (dd/mm/yyyy) *
Gender *
Male
Female
Highest Qualification (Degree, name of awarding institution) *
Residential Address *
State *
Select State
Andaman & Nicobar Islands
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Dadra & Nagar Haveli
Daman & Diu
Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu & Kashmir
Jharkhand
Karnataka
Kerala
Ladakh
Lakshadweep
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Puducherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
ZIP/Postal Code *
Nationality *
Phone Number *
PAN Number (For IHSC's Accounting and Taxation Purposes) *
Declaration: I hereby declare that I am a citizen of India as per the Income Tax Act *
2. My occupational status is *
Working Professional
Student (Under/ Post Graduate/ Equivalent)
PhD Scholar
3. Professional Information *
Overall Experience in Health Sector (number of years) *
Area(s) of Expertise *
Name of Current Employer *
Current Designation *
Office Address *
State *
Select State
Andaman & Nicobar Islands
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Dadra & Nagar Haveli
Daman & Diu
Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu & Kashmir
Jharkhand
Karnataka
Kerala
Lakshadweep
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Puducherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
Telangana
Ladakh
ZIP Code *
Official Email Address *
3. Professional Information (UG/ PG Student) *
Currently Pursuing (name of Degree) *
Name of Institution *
Student ID Expiry Date (dd/mm/yyyy)
Course Completion Date (dd/mm/yyyy) *
Dissertation Topic *
Dissertation Guide/ Supervisor *
Interest/ Focus Area(s) *
Address *
State *
Select State
Andaman & Nicobar Islands
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Dadra & Nagar Haveli
Daman & Diu
Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu & Kashmir
Jharkhand
Karnataka
Kerala
Lakshadweep
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Puducherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
Telangana
Ladakh
ZIP Code *
3. Professional Information (PhD Scholar) *
Name of Institution *
Name of University *
Student ID Expiry Date (dd/mm/yyyy)
Course Completion Date (dd/mm/yyyy) *
PhD Topic *
Name and email ID of PhD Guide *
Interest/ Focus Area(s) *
Address of Institution *
State *
Select State
Andaman & Nicobar Islands
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Dadra & Nagar Haveli
Daman & Diu
Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu & Kashmir
Jharkhand
Karnataka
Kerala
Lakshadweep
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Puducherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
Telangana
Ladakh
ZIP Code *
4. My Best 3 Publications are (insert full citation in 3 separate text boxes below) *
Note: Publications including but not limiting to journal articles, books, reports, media articles, etc.
Publication1
Publication2
Publication3
Insert N/A if you don't have a publication
Research Gate Link (type NA if you don't have any)
ORCID Number (type NA if you don't have any)
5. I want to become an IHSC member because *
6. My expectation from IHSC are *
7. I came to know about IHSC from *
Word of Mouth
LinkedIn
IHSC team reached out to me
Worked earlier or currently working with IHSC
Other (please specify)
Other
8. If you have any Suggestions/ Remarks/ Comments, please add them here
9. Upload your updated CV here (pdf/doc)*
10. Upload your Student ID here (jpg/png). (Only for UG/ PG Students/ PhD Scholars)
Submit
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People
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