Dehradun Orthopaedic society

MEMBER REGISTRATION

BECOME A MEMBER - REGISTRATION

Resident Doctors/PG/Senior Residents Charges: Rs 500 per year

Associate Membership Charges: Orthopaedic Surgeons Rs 1000 per year

Life Membership: Rs 5000 (one-time)

E-Certificates will be issued to the members in due course of time.

Dear Sir,

I wish to apply for the LIFE/ASSOCIATE Membership of DOS

Name (Block Letter) :

Organization & Address :

Designation :

Telephone :

Permanent Address :

Email :

Mobile No :

Date Of Birth:

Qualification	Institution/University	Year of Passing
MBBS
MS (Ortho)/D Ortho

Membership No IOA :

Membership No UA IOA :

Eligibility for

Life Membership	PG Degree / Diploma in Ortho	Fee 5000/-
Associate Membership	PG Student	Fee 1000/- Per Annum

Payment Details

Bank Account Name : Dehradun Orthopaedic Society

Online transfer to Account Number : 503302010006923

IFSC Code : UBIN0550337

Please Send Softcopy of MCI Registration, PG Qualification, Passport Photograph

MCI Registration:

PG Qualification:

Passport Photograph:

IOA Certificate:

UAIOA Certificate:

Membership is subject to ratification in the subsequent GBM of DOS & Allotment of Membership number will follow the ratification