IMA MSN - Medical Students Network : Join

* marked fields are required to fill.

IMA - Medical Students Network (MSN) registration fee is Rs. 500/- one time.

Note : Please do not prefix Dr. in Name.

First_Name : * (required)

Last_Name : * (required)

College :

Year_of_study :

Year of Admission :

Email : * (required)

Mobile : * (required)

Date of Birth * (required):

Blood_group :

Current_Address:

Current_City :

Current_State :

Current_Pin :

Permanent_Address (Enter address in a single line):

Permanent_City :

Permanent_State :

Permanent_Pin :

Upload proof of college (College ID Card /College fee receipt / College bonafide) (3 MB Maximum Image file) :

Upload a Picture (512 KB Maximum Image file) :

Upload valid id proof approved by Government of India (Adhar Card, Pan Card, Passport etc) (3 MB Maximum Image file) :