Member Registration




Any Queries Regarding Technical Assistance, Please Contact A1 Logics 0824 – 4252005 (9:00 AM – 6:00 PM Working Days)

Please, Make Sure You are Ready With the Soft Copies of the Following Records Before You Register.
  • Photos
  • BDS/MDS Certificates
  • Payment Reference Copy
(*) Fields Are Mandatory


Basic Info

* Name :
* Date of Birth : Note : Date of Birth format should be dd/MM/yyyy

* Gender :


* Phone Number :

* Photo :
Note : Photo Extension Should be .gif/.png/.jpg/.jpeg/.bmp Format  



Address

* Contact Address :
* College Address :

Clinic Address :


Qualification

* Membership Type :

* Institution :

* Graduation Certificate(BDS) :
Note : File Size Should be Less Than 2MB and .pdf Format  
* Post Graduation Certificate(MDS) :
Note : File Size Should be Less Than 2MB and .pdf Format

* Qualification :

 
Other Qualification(s) :


Payment Details


Bank Details

Account Name :
Association of Conservative Dentistry and Endodontics of Karnataka
Account Number :
02452200084506
Bank Name :
Canara Bank
Branch & Address :
ABSMIDS Branch, Deralakatte, Mangaluru - 575018
IFSC Code :
CNRB0010245

* Mode of Payment :

* Amount Paid :
* Date :

* NEFT Transaction Number :
* Account Holder Name :

* Bank :
* Branch :

* Payment Reference Scanned Copy : Note : File Size Should be Less Than 2MB and .pdf/.gif/.png/.jpg/.jpeg/.bmp Format  

Login Credentials

* Email Id :
(This Email Id Will be Your Login Id)
* Password :

* Re Enter Password :
 


* 6 + 6 =


Already Registered Login