___ Become Team Member Fill the form to join our team! Name Email Gender Male Female other D.O.B Father name Select your state: Andhra Pradesh Arunachal Pradesh Assam Bihar Chhattisgarh Goa Gujarat Haryana Himachal Pradesh Jharkhand Karnataka Kerala Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Odisha Punjab Rajasthan Sikkim Tamil Nadu Telangana Tripura Uttar Pradesh Uttarakhand West Bengal District Choose your course*: Select your course B.Pharm D.Pharm M.Pharm Pharm.D Appearing Student Pharmacist Reg no. Address Mobile No. Candidate photo Upload Aadhar Pharmacist Reg Certificate Membership Plan 500 rs - FOR 1 YEAR MEMBERSHIP 1000 rs - FOR 5 YEAR MEMBERSHIP 2000 RS - FOR LIFETIME MEMBERSHIP Membership Fee Scan QR to Pay: Fee receipt screenshot Declaration Membership Undertaking Certified that the information furnished in this form are true to the best of my knowledge and belief. I shall abide by all the rules and regulation of United Pharmacist Association (UPA INDIA). Further to state that I took the membership of UPA INDIA with my own conscious without anybody’s pressure or influence. Submit
