Name *

Email *
Confirm Email *

Mobile *

Registering As * -- Select -- Private Practitioner In Service Teacher

Address - Residence *
City *

Gender * -- Select Gender -- Male Female
Blood Group * -- Select Blood Group -- O Positive O Negative A Positive A Negative B Positive B Negative AB Positive AB Negative
Marital Status * -- Select Marital Status -- Single Married Widow Widower Separated Divorced
Birthdate *

Qualification * -- Select Qualification -- BAMS BAMS MD BAMS MD PHD BAMS MS BAMS MS PHD BUMS

Expected Branch For Membership
Select District * --- Select District --- Ahmednagar Akola Amaravati Aurangabad Beed Bhandara Buldhana Chandrapur Dhule Gadchiroli Goa Gondia Hingoli Jalgaon Jalna Kolhapur Latur Mumbai Nagpur Nanded Nandurbar Nashik Osmanabad Palghar Parbhani Pune Raigad Ratnagiri Sangli Satara Sindhudurg Solapur Thane Wardha Washim Yeotmal List Of Districts where NIMA Branches are active
Select Branch * --- Select Branch ---

Passport Photo * Min : 30 KB / Max 300 KB

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MCIM Registration Certificate Image * Min : 100 KB / Max 500 KB

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Degree Certificate Image * Min : 100 KB / Max 500 KB

Verification Code