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Chhattisgarh Allied Health Professionals
Welfare Association · Registered Body
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Apply for Membership
सदस्यता के लिए आवेदन
Fill the form to become a member. Annual fee: ₹500 · Lifetime: ₹5,000
Full Name *
Father / Husband's Name *
Date of Birth *
Gender *
Select
Male
Female
Other
Mobile *
Email *
Aadhaar Number
Discipline *
Select
Medical Lab Technology
Radiography / Imaging
Physiotherapy
Pharmacy
OT / Anaesthesia Technician
Optometry
Dialysis Technician
Dental Hygienist
Respiratory Therapist
Community Health Worker
Other
Qualification *
Year of Passing *
Current Workplace
Designation
District *
Select district
Raipur
Bilaspur
Durg
Bhilai
Korba
Rajnandgaon
Jagdalpur
Ambikapur
Membership Type *
Select
Annual — ₹500
Lifetime — ₹5,000
Full Address *
I certify the details are correct and I agree to the association's bylaws and code of conduct.
Submit Application