The Institution of homoeopaths Kerala

Application for IHK Membership

Name
Age
Sex	Male Female
Address(Resi)
Telephone(Resi)
District
Address(Office)
Telephone(Office)
Mobile Number
Email-address
Photo
Homoeopathic Qualifications with years
Name of University/Council/Board which awarded the Degree/Diploma
Registration Number State's.
Central(CCH)
Special Interest	Homoeopathic Education Research Clinical Practice

I wish to be enrolled as a member of the Instituition of Homoeopaths Kerala. I do hereby undertake to abide by the rules and regulations of the institution as are in force or amended from time to time , and if enrolled as requested. I shall remit my enrollment fee and membership fee as may be prescribed

Place
Date
Signature(Accepting the above statements)

Introduced by
1.
2.

Members of Unit...

The Institution of Homoeopaths Kerala