Membership Subscription

Applying From Membership Type

Membership Type

Applying From State

State

The provision of direct membership is only for those, who are in Defence/All India Central Govt. Service like Railways and or other similar organizations, liable for frequent All India transfer and or place where, there is no State/UT Chapter.

General Information

Name

Father’s/Husband’s Name

Date of Birth

Sex

Upload Photo

Choose file

Attach two recent passport size photographs.

Note:Upload jpeg,jpg,png only and image size must be less than 5mb

Qualifications

Year

Institution

Attach Proof

Choose file

Attach two recent passport size photographs.

Note:Upload pdf only and file size must be less than 5mb

For Life Members

Self attested copy of certificates of MBBS, PG Degree/Diploma in Radiology and copy of registration of State Medical Council is must.

For Provisional Life Members

Declaration from HoD of Radiology, Self attested copy of certificates of MBBS, and copy of registration of State Medical Council is must. Without these documents, the membership form will not be accepted.

Membership Category

MBBS Degree Certificate

Choose file

Attach two recent passport size photographs.

Note:Upload pdf only and file size must be less than 5mb

MBBS State Medical Council Registration Certificate

Choose file

Attach two recent passport size photographs.

Note:Upload pdf only and file size must be less than 5mb

HOD Letter/Bona Fide Certificate

Choose file

Attach two recent passport size photographs.

Note:Upload pdf only and file size must be less than 5mb

IT SHOULD BE ON THE LETTERHEAD OF THE INSTITUTE/HOSPITAL.

IT SHOULD BE RECENTLY DATED.

SEAL/STAMP OF HOD (NAME OF HOD SHOULD BE MENTIONED IN THE SEAL)

PG Degree Certificate

Choose file

Attach two recent passport size photographs.

Note:Upload pdf only and file size must be less than 5mb

PG State Medical Council Registration Certificate

Choose file

Attach two recent passport size photographs.

Note:Upload pdf only and file size must be less than 5mb

Professional Information

Name of Medical Council of Registration

Registration No.

Date of Registration

Area of Specialization

Designation

Attach Proof

Choose file

Attach two recent passport size photographs.

Note:Upload pdf only and file size must be less than 5mb

Contact Information

Mailing Address

Country

State

City

Pin Code

Tel. Nos.

Mobile No.

E-mail id:

Permanent Address

Same As Above

Permanent Address

Country

State

City

Pin Code

Tel. Nos.

Hospital/Institution/Clinic Address

Country

State

City

Pin Code

Tel. Nos.

There will an email sent to the proposer and seconder. Once they approve, your application will be processed from IRIA office. You are requested to inform the proposer and seconder to approve your application.
Proposed by (Life/Emeritus member of IRIA)
Note: Enter IRIA Life Membership Folio No It will display remaining details.

Name

IRIA Life Membership Folio No

Mobile No

E-mail id:

Attach Proof

Choose file

Attach two recent passport size photographs.

Note:Upload pdf only and file size must be less than 5mb

Attach Proof (scanned copy of any of the following IDs: PAN Card, Driving Licence, Voter ID Card, Aadhar, Passport, ID Card issued by IRIA HQ)

Seconded by (Life/Emeritus member of IRIA)

Note: Enter IRIA Life Membership Folio No It will display remaining details.

Name

IRIA Life Membership Folio No

Mobile No

E-mail id:

Attach Proof

Choose file

Attach two recent passport size photographs.

Note:Upload pdf only and file size must be less than 5mb

Attach Proof (scanned copy of any of the following IDs: PAN Card, Driving Licence, Voter ID Card, Aadhar, Passport, ID Card issued by IRIA HQ)

Membership Subscription

Applying From Membership Type

Applying From State

General Information

Qualifications

For Life Members

For Provisional Life Members

Membership Category

Professional Information

Contact Information

Permanent Address

Hospital/Institution/Clinic Address

Seconded by (Life/Emeritus member of IRIA) Note: Enter IRIA Life Membership Folio No It will display remaining details.

Seconded by (Life/Emeritus member of IRIA)

Note: Enter IRIA Life Membership Folio No It will display remaining details.