APPLICATION FORM


EDUCATIONAL QULIFICATIONS
Qualification Name of the Institution & Address Degree with Year of Course Completion Duration of Program
Post-Graduation
Under-Graduation *
+2/VHSE/Pre-Degree *
SSLC *
ADDITIONAL QUALIFICATION

Whether a member of any other Medical Association: Yes No

Any other relevant Particulars:

Attach File
MEMBERSHIP TYPE
Normal  Emergency 
PAYMENT DETAILS
Payment mode: Bank Transfer
DECLARATION
  • I understand that the decisions taken by the KAPC State Committee is final in all matters.
  • I hereby agree to work as per the terms & conditions rolled out by KAPC.
  • I understand that the KAPC reserves the right to accept or reject and to cancel the empanelment process at any time prior to the award of membership, without detailing any specified reason whatsoever.
  • I hereby declare that all the statements made in this application are true, complete and correct to the best of my knowledge and belief. In the event of any information being found false or incorrect or ineligible and deleted before or after the verification, I hereby convey my consent for cancellation of my membership.

Kerala Association for Physiotherapists Co-ordination (KAPC)

Website: www.kapc.in