Membership Application Form

Please complete the form below to apply for new membership or renewal of membership with HRCPC.

APPLICATION TYPE

Application For *

New MemberRenewal of Membership

APPLICANT DESCRIPTION

Name in Full *

S/o, D/o, W/o

Name as on Membership Card *

Present Address *

Present Address PIN Code *

Phone / Mobile / Fax

Permanent Address

Permanent Address PIN Code

Permanent Phone / Mobile / Fax

Mobile Number *

Email ID *

REFERENCE

Please provide details of two close friends / relatives who can be contacted as references.

Reference 1

Name

Phone / Mobile

Address

Reference 2

Name

Phone / Mobile

Address

MEMBERSHIP PLAN & FEE

Please select the membership category you wish to apply for.

General Member - ₹5,000

State Membership - ₹12,000

National Membership - ₹20,000

Student Member - ₹1,200

PAYMENT DETAILS

Payment Method

UPIBank TransferPayment Gateway

Transaction / Reference ID

Payment Date

Note: Please complete the payment through the official HRCPC payment method and keep your transaction/reference details for verification.

REQUIRED DOCUMENTS

Upload Member Photograph *

Upload Payment Screenshot / Receipt *

Upload Signature *

DECLARATION OF APPLICANT

I hereby declare that the information provided by me in this application form is true and correct to the best of my knowledge and belief. I understand that providing incorrect or misleading information may affect my membership application.

I agree to abide by the rules, policies and guidelines applicable to HRCPC membership.

After submission, the HRCPC team will review the application and contact the applicant regarding the next steps.

Membership Application Form