Membership Form – Indian Psychiatric Society Andhra Pradesh Branch

Membership Form

IPS National Membership

IPS AP State Branch Membership Form

IPS AP State Branch PG Membership

IPS South Zone Membership Form

IPS Social Security Scheme

IPS South Zone Membership Form

IPS National Membership

IPS Social Security Scheme

PG Membership Form

Life Regular / Life Associate Membership Application Form

Membership Type *

Full Name *

Date of Birth

Father / Husband Name *

Telephone Residence

Telephone Clinic

Mobile *

Mailing Address

Permanent Address

PIN/ZIP Code *

PIN/ZIP Code *

Email

Qualification

Year of Passing

University Name

Professional Training & Experience

Designation

Institutions Name

National IPS Membership No.

Membership Category Applied for

The primary objective of the society is to encompass the overall enhancement of mental health services in Andhra Pradesh.

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Hon. Secretary's Office

Dr. I. Sarath Chandra

Door# 13-1-43, Manasa Hospital, Old club road, Kothapet, Guntur-522001, Andhra Pradesh.

Phone No.

+91 - 95732 36486

Email ID

secretary@ipsap.org

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