AHPI

Executive Membership Registration

Hospital Corporate Group Registration Form

Name of hospital group *

Number of hospitals *

Address *

District/ City *

State *

Pin Code *

Phone *

Email *

Contact Person Name *

Landline Number *

Mobile Number *

Contact Person Email *

Designation *

Total Number of Beds (Optional)

Location of corporate office *

Website *

Already existing Member ( Affiliate) *

CIN number *

CEO / Managing Director *

Mobile (Executive) *

Email (Executive) *

Subscription *

Choose a payment method *

Total (Membership Fees + 5% Platform Charges + Taxes)

₹ 61,500.00

Inclusive of all applicable GST & administrative charges