Membership Registration

Karnataka Medical Radiographers & Allied Technologists Association

Affiliated to Society of Indian Radiographers (SIR) & International Society of Radiographers & Radiological Technologists (ISRRT)

KMRATA Life Membership Registration Form

Keep the following things ready before filling the Registration form

Scanned copy of your recent passport-sized photograph.
Scanned copy of your professional qualification certificates.
A valid government-issued photo ID proof (e.g., Aadhaar, Passport).
Your contact details including phone number and email address.
Bank account details for fee payment (if applicable).

Full Name*

Date of Birth*

Mobile No*

Email ID*

Residential Address

Pincode

Passport Photo

Professional Information

Professional Qualification

Diploma University Year of Completion

Degree University Year of Completion

Any Other University Year of Completion

Student Information

Current Education University Tenttative Year of Completion

Name of the Hospital Presently Working:

Designation:

Hospital Address:

Pin Code:

Faculty Information

Teaching Experience:

Present University/Hospital/College Name:

Transaction Information

Transaction Done ID*

Bank*

Amount Paid*

Payment Reference No

Referred By Name

Contact Mobile No:

Membership Amount Rs 1500/-

Bengaluru

+91 96635 06126

[email protected]

Registration Form