Online Member Registration Form

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Categories of Membership –

(1) Physician: Physician members include the allopathic doctors only (MBBS, MD, MS, DM, MCH, DNB or equivalent degree) who hold a valid medical license as recognized by the Medical Council of India.

(2) Affiliate Member: Affiliate members include related allied health professionals- evidence based (Dietitians, Physiotherapist, Occupational therapist and Clinical Psychologist) who will team up with allopathic physicians to support the Lifestyle Medicine movement in India through ISLM.

(3) Students : Medical Students from above 2 specialties (MBBS / Specific Allied Health Specialties)

How to Apply for Membership –

Application should be made in the prescribed form. Along with the application for membership of ISLM, photo copies of the following documents should be submitted -

• Photo copies of the M.B.B.S. ( mandatory) & Post Graduation Certificates (as per degrees listed in your application (optional)
• Photo copies of the degrees registration certificates with State Medical Council OR National Medical Council of India (as the case may be).

Membership Fee –

The Membership Fee Structure is as follows: (you can add the dollar equivalent also)

Membership Category 1 YEAR 3 YEAR 5 YEAR
INR USD INR USD INR USD
1.Physician 3000 37.50 8000 100 13,200 165
2.Affiliate 2000 25 5000 62.50 8200 102.50
3.Student* 500 6.25 - - - -
4.Foreign National (Physician) 6000 75 16,000 200 26,400 330
5.Foreign National (Affiliate) 4000 50 10,000 125 16,400 205
6.Foreign National (Student)* 640 8.00
* Please note that the membership for Student Members is only valid for a year and must be renewed each year by submitted a copy of a student ID and letter from the Head of Department of the Couse in which the student is enrolled.

NOTE : 18% GST is applicable(Excluded)

All fields marked with asterisk * are mandatory

Membership Application Form

Personal Details

Please attach a stamp size photograph (3x2.5cms) with this application and file size of the image should be less than 2 MB:

Qualification(Medical Related Only - MBBS Mandatory)

Areas of Interest

(Choose max three & to be kept editable in member profile, since bulks emails will be required to send to members who choose these areas of interest a.k.a Member Interest Groups (to which backend information will be updated like word/PDF/audio/video,etc) )

Proposer Details