Indian Institute of Alternative Medicines 
80, Chowringhee Road, Calcutta-700 020
Affiliated with
INDIAN BOARD OF ALTERNATIVE MEDICINES


Online Membership / Fellowship Form

INTERNATIONAL ALTERNATIVE MEDICAL ASSOCIATION

Name:

Date of Birth:

Sex:

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Qualification/Titles:

Membership/Fellowship of other Assoc./Soc.:

Achievements/Awards:

Modalities Practices, Specialties & Special Interests:

Professional Address-Street:

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Residential Address:-Street:

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Tele.(Home):

Tel.Office:

Fax-Home:

Fax-Office:

E-mail:

  

Website, if any:

Payment Details:-Bank Name:

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Note:Payment should be made in the name of 
"Indian Institute of Alternative Medicines"
80, Chowringhee Road, Calcutta-700 020 India
Membership Fees:US$100.00

Fellowship Fees:US$200.00

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