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Indian Association of Clinical Cardiologist - ACC India
IACC Logo
IACC Life Membership Form 2016
ECHO WORKSHOP CEDET 16
FIACC Application Form
User Name : Password :
 

Home > Member Registration

Title: *
Name *

Last Name *

S/o*

DOB *
Age
Regional Center*
IGNOU ID No*
[7-9 digit]
Study Center*

Note: If your study center is not in ithe list given above, select "others" from the drop down menu and enter your study center in the box given below.
Address(o)*
Address(R)*
Phone(R) *
Phone(M) *
Phone(O) *
E-mail*
State*
City*
PIN Code*
Enter the captcha
verification code shown above :*
I agree: This is only a preliminary membership. For Full time life membership of IACC with all the benefits, please download the LIFE MEMBER APPLICATION from the website and send it to the Head office with necessary attachments.