Gapio Membership

Title*

Passport Size Photo*

First Name*

Last Name*

Primary Medical Qualification*

Additional Qualification*

Speciality*

Registering body/Medical Council/American Board*

Registration/Licence Number*

DOB*

Email*

Select Country

Town

Postal Code

Permanent Address*

Telephone*

Area Code

Phone Number

Mobile*

Current Occupation: In service /Self-employed/Retired/Students*

Name of the Employer/Organization*

Position

Are you member of any association overseas

Yes

Are you member of any association in India

Yes

Name/s of the relevant association/s and name of country

Please include a statement of the contribution you may have made in the health care sector

Acceptance Declaration:
I hereby apply to become regular member of GAPIO and declare that all the particulars mentioned above are true to the best of my knowledge and belief and nothing has been concealed therein. I further undertake to abide by the rules and regulations of GAPIO. I further declare that I am in good standing with main registration body/ medical council.

Since this from is submitted online, therefore no signature is required.

Date

Please attach the self attested copy of the following documents: *

Registration Certificate*

Driving License / Passport*

Medical Degree certificate*

Acceptance Declaration:
Amount of Admission Fee for Regular Members: INR 2950/- (Two Thousand Nine Hundred and Fifty Only) or equivalent in foreign currency.
Please send completed application form with payment through cheque drawn in favour of "Global Association of Physicians of Indian Origin" to:

I understand that membership formalities will not be complete in the absence of my KYC documents. Therefore I will submit the KYC documents within 15 days.

Benefits of being a regular member of GAPIO

Connecting with physicians from across the globe with similar interests.
Participation in research and community projects being undertaken by GAPIO.
Opportunities to give back to the community.
Leadership opportunities for members, so inclined and a chance to serve on GAPIO Committees.
Mentorship for young Indian doctors going to USA, UK, Canada, Australia, Russia, Middle East and Africa.
Mentorship for young 2nd generation of Indian origin doctors coming to India from USA, UK, Canada, Australia, Russia, and Africa for observer-ships.
Access to online newsletter.
Opportunities to network and interact with colleagues, make new connections, sign up for events and keep up-to-date with whatever new is happening with this global group of physicians through the GAPIO website.
Recognition and awards by the fraternity for deserving young and established physicians of Indian origin.
A unified voice on healthcare and issues affecting physicians in general.

Know About Our Membership Fee – GAPIO Membership Program

Regular members: Any *Physician of Indian origin residing in India or abroad may apply in the prescribed format to the Executive Committee of the society for a regular membership. The Executive Committee will consider the application and may either accept or reject the same.

Kindly fill the membership form to become a member of GAPIO

* The term “Physician” has been used as a broad term for “Doctor” working in any specialty whether medical or surgical.

I. Rs. 2950/- or equivalent to this amount in foreign currency for becoming a regular member.

II. Rs. 1180/- or equivalent to this amount in foreign currency from fresh medical graduates having cleared the examination during the last calendar year or during the current year, Residents and current DNB trainees. (Please submit the mark sheet/Degree certificate)

Our Bank-details to Transfer Membership Fee – GAPIO Membership Program

(For remittance in India)		(For remittance from overseas)
Name of account	Global Association of Physicians of Indian Origin	Name of Beneficiary	Global Association of Physicians of Indian Origin
Name of Bank	Punjab National Bank (Earlier Oriental Bank of Commerce)	Name of Bank	Punjab National Bank (Earlier Oriental Bank of Commerce)
Name of Branch	Apollo Hospitals New Delhi India 110076	Name of Branch	Apollo Hospitals New Delhi India 110076
Account Number	50761131000189	Account Number	50761131000189
Type of Account	Current Account	Type of Account	Current Account
IFSC Code	PUNB0507610	Swift Code	PUNBINBBISB

Purpose of remittance: Membership Fee of Global Association of Physicians of Indian Origin

Important : In case of remittance of membership fee from India or overseas, a completed membership application form should be sent separately along with particulars of Transaction ID or particulars of bank transfer advice in order to reconcile the payment.

CHARGES IF ANY BY FOREIGN BANK TO BE BORNE BY THE SENDER.

# Please mention name of the applicant / member at the time of remittance