Medical/ Dental Practitioner Registration:

Eligibility and Requirements:

For membership as Medical/ Dental Practitioner, the delegate must have completed the following:

Completed Basic or Advanced Medical/ Dental qualification, such as MBBS, MBBChB, MD, DO, MS etc.)
The basic Medical/ Dental qualification must be from a recognized medical school, listed in the world directory of schools (
Advanced Medical/ Dental Qualifications, only 3 can be uploaded. Upload the most relevant to your practice.
Must be licensed practitioner or a practicing practitioner in the city/ state of domicile or license from a country where the delegate had practiced.
Returning to practice or non-practicing practitioners*, may request membership committee review of their case*. (


*In cases like these all evaluations are done by the membership committee and a report is forwarded to the executive education board. The president along with the board gives the final decision on such cases. Decision by the board is final and if any action plan is given to the delegate the same must be followed, else the delegate risks losing the membership.

Before proceeding further, kindly make sure the following documents are available for attachment to this electronic form.

Personal Identification:

Government Issued ID** (Showing complete Doctor name and Father’s/ Husband’s Name)
   *Official Passport, Official Identification Card or Drivers’ License only. Hospital ID, Work ID will no be accepted as         an official document.
Passport Size Photograph
Educational Qualification/ Licensure:
Color Scan copy of the Basic Medical/ Dental Qualification
Color Scan copy of all Advanced Certifications/ Qualification, if mentioned in the e-form of registration
Color Scan copy of Licensure(s)
Updated CV/ Resume

New Medical/ Dental Practitioner Membership FORM:


    Personal Information:
    First Name*
    Middle Name*
    Last/Family Name *
    Date of Birth*
    Country of Practice*
    Attach Government ID*
    (Passport, Official ID or Driver’s License)
    Attach Passport Size Picture*

    Contact Detail:
    Mailing Address, Line 1*
    Mailing Address, Line 2
    Zip Code/ Postal Code*
    Contact Phone (Mobile)*
    Contact Phone (Home)*
    Contact Phone (Work)
    Email Address (Personal)*
    Email Address (Work)

    Social Media Details:
    WhatsApp Number*
    Instagram ID
    Facebook ID
    Linkedin ID

    Work/ Practice Place Details (If Practicing):
    Name of Work place

    Medical/ Dental Education Details:
    Name of Basic Medical/ Dental Qualification*
    Date of Graduation*
    University of Awarding the Qualification*
    Country of Graduation*
    Attach Certificate*


    Any Advanced Certification and Qualifications 01
    Date of Completion
    Attach Certificate


    Any Advanced Certification and Qualifications 02
    Date of Completion
    Attach Certificate


    Any Advanced Certification and Qualifications 03
    Date of Completion
    Attach Certificate

    Practice Licensure Details (If Any):
    Medical/ Dental Practice License Number
    Medical/ Dental Practice License Issuing Country
    Attach License Copy

    Attached Any Additional Documents here:
    Attach CV/ Resume*
    Name to be printed on the Membership Certificate/ Card*