Your name*

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Gender*
MaleFemale

Date of Birth*

Personalised T Shirt Size*

Your email*

Mobile No.*

Mailing Address* (with Pin Code) -

Academic Qualification*

Specialty*

Kindly upload your MBBS Degree*

Kindly upload your MD Degree (if applicable)

Experience in Emergency (in Years)

Experience proof

Current Posting (Institution)

Where did you hear about the organization?

Area of Interest*
AdultPaediatricGeriatricTraumaObstetricsResuscitation

Membership Criteria
Associate Life Member (MBBS more than 2 years of experience/ Any fellowship in Emergency Medicine)Permanent Life Member (MD/DNB/DM/MCH/MEM/MRCEM/ MBBS with more than 5 years of Experience)

Membership Fees
Associate Life Member (Rs. 2100)Permanent Life member (Rs. 3000)

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Note-

1- The Membership Fee is non-refundable & not adjustable in any circumstances.

2- In Case of Termination/Resignation from the Membership, the use of all official SACTEM belongings including Membership Card will become invalid & its responsibility of Member to return it to Chief Convener, SACTEM.