AMPI Know Your Membership – Update form ! – Association of Medical Physicists of India

Please enter full email address or AMPI Number in full, ex: LM-1234

1. Identity & Photos

AMPI No

Email*

Mobile*

Aadhaar Number*

Title

First Name*

Last Name*

Display Name*

DOB*

Photo*(Allowed: jpg, png files not to exceed 150Kb)

Aadhaar Document Image*(Allowed: jpg, png files not to exceed 150Kb)

2. Contact & Address

Address Line 1*

Address Line 2

City*

State*

Country*

Pin Code*

3. Professional Details

Current Designation

Current Organization*

Organization City*

Work Area*(Please select one or more)

Diagnostic Radiology

Radiotherapy

Nuclear Medicine

Industry

Research

Teaching

Occupation*(select one core role, most appropriate)

4. Qualifications

5. Regional Chapter & ID

I am a member of a Regional Chapter

Chapter Name

Chapter Membership No (if available)