Application form for life Membership

Academic Details:

M.B.B.S
Post Graduation
DETAILS

1. Life membership fee Rs. 6000/-and 400 US Dollars for Foreign Delegates.
2. Payment to be made only by D.D/Cheque in favour of “The Indian Society of Otology, Chennai
3. Please send your passport size photograph and write your name behind the photograph.
4. Please send a photocopy of your MS ENT / DLO/ DNB ENT certificate.

Payment can also be made through RTGS as per details given below:

Wire Transfer in favour of
::
    INDIAN SOCIETY OF OTOLOGY
Wire Transfer Account No
::
    400658851
Bank Name
::
    INDIAN BANK
Branch
::
    KELLYS BRANCH
IFSC Code
::
    IDIB000K071
Please send your bank payment confirmation slip along with your application form.