Member Registration

*Fields marked with a red asterisk are required

Access Details

*User Email ID :

Your Email Address

	Your Emal ID will be the user name to login to your India Health Card account in the future.
	We take your Email security seriously.
	Your privacy is our priority. We assure you that we will not release your information to anyone.

To ensure proper delivery of our emails, add online@indiahealthcard.com to your address book,
trusted sender list or company white list.

*Password :

6 to 16 characters

*Confirm Password :

Retype password to confirm

*Type of Card :

Individual Card Membership Fee $7Family Card Membership Fee $15

Security Question :

Answer :

Personal Details

*First Name :

Middle Name :

*Last Name / Initials :

Date of Birth :

MM/DD/YYYY

Sex :

MaleFemale

*Address 1 :

Address 2 :

*Country :

State/Province :

City :

Zip/Pin Code :

Phone Number :

Mobile Number :

How did you hear about us?