Sign-up - Homoeopathic Medical Publishers - Enrollment System

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Membership Type *	Insight Alliance Homoeopathic ($100.00) A voice that represents the entire Homoeopathic community. A resource that all homeopaths can use worldwide. Discussion Forum, Live Chat, Cases, Articles & Archives
Payment System *	Available Payment Options - Check your email to complete payment. Account will be activated after receipt of full payment.
Your Name * Your First & Last name
Your E-Mail Address * A confirmation email will be sent to you at this address
Choose a Login Name (User ID) * It must be 4 or more characters in length and may only contain small letters, numbers, and the underscore '_'	check for uniqueness
Choose a Password * Must be 4 or more characters
Confirm your password * Enter password again
Age * Age of enrollee
Gender * Select your gender	Female Male
Telephone Residence Your residential telephone number
Telephone - Clinic / Office * Your Clinic / Office Telephone Number
Mobile Number/s Your mobile number/s
Organization (if applicable) Mention the name of organization if you belong to one.
Do you work within a: * Your working pattern	Group Consultancy College Solo Practice Other
Working Pattern (if other) If your working pattern is not listed in the above field, please specify here
Working Hours Is your practice part time or full time?	Part Time Full Time
Duration of Practice * How long have you been practicing?	0-1 student 1-3 years 3-5 years 6-10 years 10 years+
Memberships Do you belong to any association/society?	Association Society No I am not a Member
Association / Society If you are a member or belong to a Association / Society write the name here.
Name of Pharmacy Which pharmacy do you use?
Homoeopathic Software Do you use a computer repertory?	Cara Mac Rep Reference works Radar Hompath EH Vital Quest Other
Homoeopathic Software - Other Write the name of software here if it is not mentioned in the above list.
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