Membership Form | Academy of Clinical Microbiologists

Academy of Clinical Microbiologist

Application Form for Membership

Full Name (Enter full name without Dr.)

Email ID

Mobile Number

Date of Birth

Age

Gender

Residential Address

Address for Correspondence

Qualification

Professional Experience

Current Employment & Professional Affiliation

Membership

Transaction ID

MBBS Certificate (PDF, Size: 5MB max.)

MBBS Registration Certificate from Medical Council (PDF, Size: 5MB max.)

MD Degree Certificate (PDF, Size: 5MB max.)

Payment Proof (Image/PDF, Size: 5MB max.)

* The Annual Membership is valid for one year from the date of registration. ** Please note that the validation and verification of the data you provided may take a few business days. *** Confirmation of registration, along with the certificate and receipt, will be sent to your registered email once the verification process is complete.