Become a FERCI Member

Membership Plans

Life Membership Fee	Rs. 5,000
Institutional Membership Fee for five years Five members can attend annual FERCI conference at concessional rate	Rs. 50,000

* Title Dr. Mr. Mrs. Ms. Institute

* Name

* Address for Correspondence

* State

* City

Residential Phone including STD Code

Clinic or Office Address

Phone (Clinic or Office, including STD Code and extension if any)

* Mobile No.

* Email

* Professional Qualifications

* Specialization(s)

* Position

* Organization

Ethics Committee : Member/Member Secretary/Chairperson

Investigator

Institute / Site :

* Type of Membership (Choose any one)

* Details of Payment done (Choose any one)

* Date of payment

By applying for the membership of FERCI, you are approving of its objectives.

* Code :