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Provide your personal information to complete registration process

Note: For any date related field, click on the dropdown arrow in the field and select dates from the calendar. Maually typing dates will give an error
First Name (required)*

Middle Name

Last Name (required)*

Date of Birth

Email(required) *

Qualification (required) *

Select membership/subscription plan *

Membership/subscription plan amount

Membership/subscription plan currency

upload profile picture(only .jpg and .png accepted)*

Year Of Passing

Blood Group

Mailing Address (required) *

Mailing Address Pincode (required) *

Tel. No.

Mobile Number(required) *

Profession

Designation

Name of the Institution

Address of Institution

Institution Pincode

Two IPA Member references (required)*
No. 1*
Name

Membership ID

No. 2*
Name

Membership ID

Select State *

Select Branch *

Select Divisional Preference *

By checking this, you accept all the Terms and Conditions as prescribed by The Indian Pharmaceutical Association. Also please note if you have checked the subscription to IJPS or Pharmatimes Box, then an email link to the payment portal will be sent