Today: November 21, 2024 12:10 pm
ishbtmail@gmail.com
English
English
Home
About us
Previous Office Bearers
Committee
President Message
Executive Member
Members
Member's List
Member's Updated List
Membership Form
Masterclass
Suggestion for Masterclass Topic
Masterclass Videos
Awards
Dr. J.C. Patel
Dr. K.C. Das
Dr. Dhirendra Nath
Best reviewer award
Life time achievement awards
Oration
Events
Upcomming Events
Past Events
Upcomming Events
Past Events
Events
Contact
Social
Login
Home
Login
MEMBERSHIP APPLICATION FORM
Personal Details
Name
Email
Date of Birth
Gender
Male
Female
City
State
Pin code
Enter Phone Number
Address
Enter Office Address
Nationality
Qualification Details
Qualification
MBBS
Name of University
Qualifying year
PHOTOPCOPY ENCLOSED
MD
Name of University
Qualifying year
PHOTOPCOPY ENCLOSED
DM
Name of University
Qualifying year
PHOTOPCOPY ENCLOSED
PHD
Name of University
Qualifying year
PHOTOPCOPY ENCLOSED
Professional positions
Professional positions held (recent):
from
to
from
to
Your work primarily related to:
Patient care
Teaching
Industry
Research
NGO
Other
Where did you get Training in?
Haematology
Oncology in India
Abroad
Publications:
Books, Chapters in Books
Membership Details
Signature of Proposer:
Name
Membership No.:
Signature of Seconder:
Name
Membership No.
ALL DETAILS MARKET with (*) , MUST BE FILLED UP. Otherwise, there will be delay in giving membership.
Subscription:
LIFE MEMBER
subscription: Rs.5000/-
Register Now