Download POS membership Form

Please note the online application form below is currently disabled and you need to contact Hon Secretary for Bank details for NEFT payment of fees.

Please download the form, fill and send it to Hon. Secretary along with details of NEFT transaction.

Dr. Mukesh Paryani, Hon. Secretary for more details.

Email: *

Password: *

Repeat Password: *

Password Strength: Too Short

Title:

Dr. Mr. Mrs. Ms. Smt.

POS Membership Number:

First Name: *

Last Name: *

Sex:

Male

Female

Email Id: *

Designation Year:

Please enter current year Ex : 2018

Membership Type:

RegularAssociateOther

Designation:

POS MemberHon. PresidentHon. SecretaryHon. TreasurerImm. Past PresidentImm. Past SecretaryHon. Vice PresidentHon. Jt. SecretaryHon. Jt. TreasurerManaging CommitteeEditor POSTERCo-Opted MemberScientific CommitteeMedicolegal and ethics committeeAdvisory CommitteePatrons

Voting Right:

Yes

No

Achievement:

Degrees:

Allopathy / Others:

Allopathy

Clinic Landline Number:

Residence Landline Number:

Mobile Number: *

WhatsApp Number:

MMC Registration Number:

Clinic Address:

City:

State:

Pin Code:

Residence Address:

Preferred Postal Address:

Clinic

Residential

Date Of Birth:

Marriage Anniversary:

Upload ICard Size Photo:

Image Number: *