Life Membership Application

Life Membership Application - New Project 1

Name of the Candidate*

Preferred name in Printing

Date of Birth

MBBS - Year - College

D.Ortho - Year - College

M.S. Ortho - Year - College

Any Other Qualifications

Presend Position*

Permanent Address

Office Address

Residential Address

Mobile Number

Fax

Email*

Repeat Email*

Website

To Which address the mailing is preferred

Permanent
Office
Residential

Are you member of IOA - If YES furnish details*

Are you already a member of Telangana Chapter of IOA - If YES - Furnish Details

Any other information the candidate wishes to furnish

Details of Subscription Rs.

UPI Transaction No.*

Date*

Bank*

Branch*

Bank Payment ScreenShot*

Degree Certificate*

PG Certificate*

TS Registration Certificate*

Attach Passport Size photo*

Please Note:

1. Please attach one Passport Size Photograph and affix one to the application 2. a) Life membership fee Rs. 3300 b) Drafts only in the name of "Treasurer, TOSA ", payable at Warangal. 3. Please send the filled application form to

Whatsapp(9246899108) And MAILID : tosa@deepthisoft.com

paid slip. With required documents send to above mail I’d

Required Documents List :

MBBS ,TSMC REGISTRATION COPY ,MS ORTHO

ADDITIONAL QUALIFICATION ,AADHARCARD

PASSPORT SIZE PHOTO, ADDRESS ,PHONE NUMBER

EMAIL ID

I agree

Download....

1. Please attach one Passport Size Photograph and affix one to the application

2. a) Life membership fee Rs. 3300 /-

2300 for PG ASSOCIATE MEMBERSHIP (bonafide certificate by HOD ) mandatory.

b) Drafts only in the name of "Treasurer, TOSA ", payable at Warangal

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

Account Name : TOSA

Account Number :

62439296497

IFSC Code: SBIN0021119

Whatsapp(9246899108) and

MAILID : tosa@deepthisoft.com

paid slip. With required documents send to above mail I’d

Required Documents List :

MBBS

TSMC REGISTRATION COPY

MS ORTHO

ADDITIONAL QUALIFICATION

AADHARCARD

PASSPORT SIZE PHOTO

ADDRESS

PHONE NUMBER

EMAIL ID