clinical research registration

Member Registration Form

Please fill up the form for the individual member registration.

Personal Information :-

Degree (required)

Salutation (required)

First Name (required)

Middle Name

Last Name (required)

Date Of Birth (required)

Email (required)

Alternate Email

Phone

Mobile (required)

Residential Address (required)

Country (required)

State (required)

City (required)

Pin Code (required)

Office Information :-

Official Address (required)

Country (required)

State (required)

City (required)

Pin Code (required)

Name of your Institution/Company/Organization (required)

Nature of Institution/Company/Organization (required)

Current Job Position (required)

Country where your Institution,Company or Organization is located (required)

Other Information

The society provides discussion forum platform for posting of queries related to professional work. Posted topic / question will be sent to your registered mailid profile in ISCR. Are you interested?
YesNo

Once all the compulsory fields have been filled in, you will be registered as a guest member. To complete your confirmed membership registration you have a choice of Life Time Membership OR Annual Membership by payment of Rs. 5000/- OR Rs. 1500/- respectively. The screen name specified here will be your user Login ID . You have 15 days to complete confirmed membership criteria, during this period you may login as a guest member and explore the privileges available to you. Please click Submit to start registration process.
Annual MembershipLifetime Membership

Preference for Communication
Official AddressResidence Address

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Member Registration Form

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