Associate Membership Application

Associate Membership Application - TELANGANA ORTHOPAEDIC SURGEONS ASSOCIATION

Associate Membership Application

Membership

ASSOCIATE MEMBERSHIP APPLICATION FORM

Name of the Candidate*

Preferred Name in Printing

PHOTO*

Qualifications*

Year

College

Any Other Qualifications

Year of Joining in Post Graduation and name of the College

Permanent Address*

Present Address

Mobile NNumber

Fax

Email ID*

Repeat Email ID*

Website

D.D. Number*

Date*

Bank *

Branch*

Letter From the HOD to be Attached*

MBBS Ceritificate*

Bank Payment Slip*

Please Note :

1. Once you obtain the Post Graduation Degree / Diploma or on completion of three years of associate Membership which ever is earlier you are entitled to enroll as Life Member of TOSA by paing Rs. 1200 /- and submiting a New Application form.
2. Please attach one passport size photograph and affix one to the application.
3. Associate Membership fee Rs. 2200 /- D.D. in the name of "Treasurer , TOSA ", payable at Warangal
4. Please send the filled application form to the following address.

Dr.B.VijayBhasker MS Orthopaedic
Secretary "TOSA"
Ravi helios hospital,
175, R.K.Math Road,
Indirapark, Hyderabad 500029
Email..drbvb1966@gmail.com
Ph 9849084566(Whatsapp)

Download....

Please Note :

1. Once you obtain the Post Graduation Degree / Diploma or on completion of three years of associate Membership which ever is earlier you are entitled to enroll as Life Member of TOSA by paing Rs. 1100 /- and submiting a New Application form.

2. Please attach one passport size photograph and affix one to the application.

3. Associate Membership fee Rs. 2200 /- D.D. in the name of "Treasurer , TOSA ", payable at Warangal

4. Please send the filled application form to the following address.

Account Name : TOSA

Account Number : 62439296497

IFSC Code: SBIN0021119

Dr.B.VijayBhasker MS Orthopaedic

Secretary "TOSA"

Ravi helios hospital,

175, R.K.Math Road,

Indirapark, Hyderabad 500029

Email..drbvb1966@gmail.com