Member Registration

Membership Registration

Fill in the form below to register as an InaHRS / PERITMI member

Membership Category *

Specialist Doctor

Cardiologist or equivalent with a recognized arrhythmia competency certificate.

Allied Professional

Nurse, Technician, or other healthcare professional with an arrhythmia training certificate recognized by PERITMI / InaHRS.

Specialist Doctor Documents

Competency Certificate *

Certificate from the Indonesian College of Cardiology or recognized equivalent.

Click to upload or drag & drop

PDF, JPG, PNG (max. 2MB)

Arrhythmia Education Certificate *

Arrhythmia education certificate recognized by PERITMI / InaHRS.

Click to upload or drag & drop

PDF, JPG, PNG (max. 2MB)

Allied Professional Documents

Arrhythmia Training Certificate *

Arrhythmia training certificate recognized by PERITMI / InaHRS.

Click to upload or drag & drop

PDF, JPG, PNG (max. 2MB)

Personal Data

Full Name *

Date of Birth

Gender *

Male Female

Phone / WhatsApp Number

+62

Enter number without leading 0, max. 13 digits.

Full Address

Account Details

Username *

Email *

By submitting this application, you agree to the InaHRS / PERITMI membership terms.