UTTARAKHAND STATE OPHTHALMOLOGICAL SOCIETY

UTTARAKHAND  STATE OPHTHALMOLOGICAL SOCIETY

( Established in 2004)

APPLICATION FOR MEMBERSHIP

1. SURNAME-                                               FIRST NAME

   2. FATHER/S / HUSBAND'S NAME

   3. ADDRESS -

    4. PHONE -   (O)                                                     ( R)                                                

                       ( M)

     5. EMAIL :

     6.. EDUCATIONAL QUALIFICATIONS

          GRADUATION-                                                                       UNIVERSITY                                        YEAR OF PASSING

           POSTGRADUATION -                                                            UNIVERSITY                                        YEAR OF PASSING

               OTHER

    7.  MCI REGISTRATION  NO.-

        STATE IN WHICH REGISTERED -

    8. INTRODUCED BY-                                                UKSOS MEMBERSHIP NO.

    9. I am enclosing DD  No .......                                   dated                            Bank

                                                                                                                                                                Applicant's Signature

Life Membership - 1. Eye Surgeon residing and practicing in Uttrakhand - Rs. 1500

                              2. Eye Surgeon not from  Uttrakhand                           -   Rs. 1000

Please send Application form completed along with DD to Dr. Amit Singh, Treasurer UKSOS, Singh Eye Hospital, Model Colony, Araghar, Dehradun 248001

 CRITERIA FOR MEMBERSHIP

The membership open to all Ophthalmologist and graduate in modern medicine who have keen interest in ophthalmology. The members not from Uttarakhand State will have all privilege except voting right.

The membership of all aplicant has to be rectfied by general house.