Membership Form

For any query related to this form contact secretary general : secretarygeneraliacam@gmail.com or click here.

Please click here to download the General Guidelines to fill the IACAM Online Application Form

Fellow/Member(Required)

Fellow

Member

Hidden

Membership Number

Title(Required)

First Name(Required)

Middle Name

Last Name(Required)

Your Email(Required)

Password(Required)

Password you enter will be the password for the unique user account that will be created for you in the website, when your application gets approved

Current Designation(Required)

Current Institutional Affiliation(Required)

Correspondence Address(Required)

Address State ZIP / Postal Code

Professional Qualifications (Starting with MBBS or MA/MSc)(Required)

Qualification

University

Year Obtained

If you have multiple qualifications. you can add qualification through click on plus button.

Professional Appointments Held (Designation)(Required)

Designation

Institution/Department

From (Month / Year)

To (Month / Year)

If you have multiple professional appointments. you can add qualification through click on plus button.

Attach soft copy of Proof of Professional degrees obtained and Experience gained - as a single PDF document here(Required)

Accepted file types: pdf, Max. file size: 5 MB.

Verification Mode(Required)

Online

Offline

Proposed by Name(Required)

Fellow Membership Number(Required)

Email(Required)

Seconded by Name(Required)

Fellow Membership Number(Required)

Email(Required)

Please attach the scanned copy of the completed application form with signature here.

You can download the Application form here: Click Here

Please attach the scanned copy of the completed application form with signature here(Required)

Accepted file types: pdf, Max. file size: 5 MB.

I have been a member of IACAM in the past(Required)

Yes

Dues are pending against me(Required)

Yes

Signature of the Applicant(Required)

Accepted file types: jpg, png, jpeg, Max. file size: 5 MB.

Photo of Applicant(Required)

Accepted file types: jpg, png, jpeg, Max. file size: 5 MB.

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Secretary General Email

President :	Dr. Devashish Konar
Vice President :	Dr. Shekhar Seshadri
Secretary General :	Dr. Rachna Bhargava
Treasurer :	Dr. Henal Shah
Editor :	Dr. Nitin Gupta

Indian Association for Child and Adolescent Mental Health

Membership Form

For any query related to this form contact secretary general : secretarygeneraliacam@gmail.com or click here.

Please click here to download the General Guidelines to fill the IACAM Online Application Form

Indian Association for Child and Adolescent Mental Health

LINKS

Contact Us

ADDRESS

OFFICE BEARERS

LINKS