U.P State Ophthalmological Society

Membership Form

Upload Passport Size Photograph* Image size should be 600 X 400 Pixels and not more than 200KB.

Upload User Signature* Image size should be 131 X 60 Pixels and not more than 200KB.

Address of Correspondence

Permanent Address

Qualifications

Copy of Degree *

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Registration No. and the State in which registered:

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Proposed By

Seconded By

Government ID Proofs

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Amount : INR 2500/-

An Internet Handling Charges of Rs. 330/- will be applied. Details will be shown at the checkout page.

Declaration: I hereby declare that the above details as correct. I wish to be a Life Member. I have carefully read the instructions overleaf. I shall abide by the Rules & Regulations and Bye-Laws of the Society as in force and any subsequent amendment(s) made from time to time.

Account Login Detail

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