First Name * Middle Name Surname *
Address for Communication (where postal mail will be sent) *
City * State *
Permanent Address *
City * State *


Phone (including STD code)
Office * Residence
Mobile * Email *
Present employment status *
Upload Proof of MCI Registration *
Upload Proof of Payment *
Upload Proof of MBBS *
Upload Proof of Post Graduation / Admission in Ophthalmology *
Upload Aadhar Card *
Proposed By *
Name
Membership No
Address
   
Seconded By *
Name
Membership No
Address
   


Declaration by the applicant

I shall abide by the regulations of the society in force and any subsequent amendments made from time to time. All information given above is true to the best of my knowledge.
Account details
Account Holder Name North Zone Ophthalmological Society
Branch Name GMCH, Sec 32, Chandigarh
Account No 10400072975
IFSC code SBIN0010607
Membership Fee's INR 2500

 
   
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