Life Membership Application

Life Membership Application - TELANGANA ORTHOPAEDIC SURGEONS ASSOCIATION

Life Membership Application

Membership

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.

D.D.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 the following address. Dr.B.VijayBhasker MS Orthopaedic TOSA secretary Ravi helios hospital, 175 R.K.Math Road, Indirapark, Hyderabad 500029 Email: drbvb1966@gmail.com Ph 9849084566(Whatsapp)
I agree

Download....

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

2. a) Life membership fee Rs. 3200 /- OASIS membership Fee Rs. 200 /- ( Total Rs. 3200.00 )

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

Dr.B.VijayBhasker MS Orthopaedic

TOSA secretary

Ravi helios hospital,

175, R.K.Math Road,

Indirapark, Hyderabad 500029

Email..drbvb1966@gmail.com

Ph 9849084566(Whatsapp)