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Membership Form

APPLICATION FOR IICHA MEMBERSHIP

Type of Membership: Full Life/Ordinary Membership

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Full Name *

Educational Qualification *

Present Designation *

Date of Birth (dd/mm/yyyy) *

Contact Phone No. *

Email *

Mailing Address *

Field of Specialization (Tick one preferably) *

Community Medicine
Public Health
MCH & FW
Health Education
Sociology / Social Work
Public Health Nursing
Public Health Engineering
Veterinary Public Health
Nutrition & Dietetics
Public Health Administration
Bio-Statistics
Psychiatry
Environment
Psychology
Tahaffuzi wa samaji Tib
Swastha Vritta
Preventive Dentistry
Others

No. of Publications in Indexed Journal *

Membership of Other Professional Association

Branch Affiliation, If any

Proposed By (Name)

IICHA Membership No.

OUR VISION

The vision of a few stalwart community of India gave birth to the idea of forming the integrated community health association mainly to provide a common forum to the Community physicians of India

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OUR MISSION

To reduce the incidence of the disease burden of communicable or non-communicable or both as the case may be in the selected geographical area during a specific period of time.

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CONTACT

Shakhe Simnan, 103, Akhlaq Apartment Civil Line, Abdullah School Road, Aligarh, 202001- Uttar Pradesh

+(91) 93680-05661

syedmsashraf@yahoo.co.in