ISPPERIO

Member Registration

Any Queries Regarding Technical Assistance, Please Contact 0824 – 4252005 (9:00 AM – 6:00 PM Working Days)

For Registration Approval, Please Contact
Dr. Ashish Jain,
Hon. Secretary- Indian Society of Periodontology
Contact No: +91 9888000444
E-Mail ID: secretaryispindia@gmail.com

(*) Fields Are Mandatory

Basic Info

* Membership Type :

Associate Life Member

* Name :

* Date of Birth :

Note : Date of Birth format should be dd/MM/yyyy

* Gender :

Male

Female

Other

* Mobile Number :

* Whatsapp Number :

* Address :

* Country :

* State :

* City :

* Pin Code :

Enter Pin Code

* Photo :

(File Size Max 2MB & Format: .gif,.png,.jpg,.jpeg,.bmp)
(Once you select photo, Please Wait for upload)

Academic Details

* Year of Joining MDS:

Select Year

* Name of Guide:

* Institution :

* University

* Upload Your Admission/Registration Slip of MDS Course as a Proof:
(only .pdf format allowed)
(File Size Max 2MB)

Login Credentials

* Email Id :

(This Email Id Will be Your Login Id)

* Password :

* Re Enter Password :

Password Mismatch

Payment Details

* Mode of Payment :

Online

* Amount:

Additional charges will be based on the mode of Payment levied by the payment gateway which would be applicable at the time of checking out.

* Date:

Enter Date