1. Name: Write your name as it was provided in your proof of identity (passport, driving license, voter’s ID card etc)
2. Age: Write your date of birth as was provided in the SSLC or Higher Secondary/ Equivalent certificate, in A.D. and in Indian Calendar (eg., 10th august 1979 will be filled as 10.08.1979)
3. Sex: Circle whichever applicable
4. Permanent address: Full Residential address, and of parents/ guardian could be provided with PIN code number.
5. Contact phone: Full International Dialling Code (In India, eg., 0091- 824- 4251625 for land lines; 0091-9448039501 for mobile).
6. Affix the colour recent passport size photo and sign across legibly.
7. E Mail ID: for electronic communication purposes only.
8. Address for communication: If same, them mention “YES”, otherwise mention your present address of work, temporary accommodation etc.
9. Your vision will take you where want to look, see and dream! Explain your vision in relation to Academics, Clinical Practice, and Research in PT.
10. Membership category: Those who have passed BPT (and studying/ completed higher studies above) is eligible for applying into Physio category and Students of BPT for Student member category. Both Indian and International members are eligible and most welcome to apply for IPTA® membership. The total amount thus for Physio life member is Rs. 1,750/- (which includes subscription and access to IPTA® Newsletter, IPTA® Journal, IPTA® website, IPTA® membership ID card, IPTA® membership certificate). Non-physio members are also specially welcome to be a part of the IPTA® and their membership is sponsored by the association. A Non Physio member thus have to fill the form with all documents except the DD. If he/she opts for ID and/or certificate, then the entry fee Rs. 250 should be paid for the same. However they are not entitled to enjoy the members’ benefits except that they can contribute in their administrative positions for the various committees and sub-committees of the IPTA®.
11. Demand Draft details: Only cash (in person only, not by post) / DD / cheques (for Indian subcontinent) are accepted. No other mode of payments.
12. Educational Qualification: For example, Students are required to mention “Doing BPT 3rd year” and fill the columns for BPT-I and BPT-II respectively. Physios need not mention in such a segregated manner and instead BPT, MPT, PhD or etc.
13. Work Experience: Include even part-time work experiences like evening clinic, internship, outside clinical postings etc. Add a sheet in same format if necessary.
14. IPTA® Administrative Positions: are open for professionals and students likewise and it is purely voluntary. Positions are for suitable persons who are life members only. Students however enjoy the exception. For the list of administrative positions, refer www.indiapt.org for structure of the committees of the IPTA®.
15. Declaration: Self sign the declaration form.
16. Check list: Tick mark the items per se.