• Membership Selection

  • Personal information

  • Address

  • Qualification

  • Recommendation

  • Declaration

Membership Selection


Membership Category

Select one from the following

Upload DM/ DNB Certificate *

It is mandatory to upload the certificate
Format: PDF, JPG, JPEG, PNG


Board Certification

Required
Upload board certificate, if any
Format:PDF

Personal Information

Required
Required
Required
Required
Required
This field is required
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Required
Upload your passport photograph
Format: JPG, JPEG, PNG, PDF

Address

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Required
Required
Required
Required
Required

Qualification

Required

Please mention your universities and year

Required
Required
Add University

Training in Cardiac Electrophysiology/ Pacing

Required

Please mention your experience in years and months for Cardiac Electrophysiology / Pacing


Present Appointment

Required

Recommendations

Please enter details of two proposers from existing members of IHRS and also send a request to respective member to confirm your recommendation.

Proposer 1

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Required
Required
Required

Proposer 2

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Required
Required
Required

Declaration

I,
Hereby solemnly and sincerely declare that, to the best of my knowledge and belief, the above particulars given by me are true and correct. In case if any of the above information is found to be incorrect, it may lead to cancellation of my membership