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<<download form>>

THE ASSOCIATION OF OTOLARYNGOLOGISTS OF INDIA
BIHAR & JHARKHAND STATE BRANCHES
2001-2002
Reg. No. 586
President
Dr. J.P. Mukherjee
Karmic Nagar, Dhanbad
Ph: 0326-202018

Vice President
Dr. CHANDRASHEKHAR		 Hony. Secretary
Dr. RANBIR K. PANDEY
53, Vaibhav Apartments
Budha Marg, Patna–800 001
Ph: 0612-228141 (R)
0612-234499 (O)
E-mail:
ranveerdoc@yahoo.com
dr_rkpandey@indiatimes.com

FORM OF APPLICATION FOR MEMBERSHIP

(For Office Use Only)

MEMBERSHIP NUMBER
Subscription Receipt No.

Elected as ORDINARY / LIFE member by the General Body from
at its meeting held .
Dated

Honorary Secretary

(PLEASE TYPE/WRITE IN BLOCK CAPITALS)
Application for   MEMBERSHIP
1. NAME IN FULL / (MR. MISS/MRS) 
     (as it should appear in ROSTER / MAILING LIST)

2. DATE OF BIRTH

3. ADDRESS
                  PIN CODE 
                        Tel No: State Code
                Office Residence
 

4. QUALIFICATIONS(Copies of certificates to be attached)

DEGREE/DIPLOMA

 UNIVERSITY YEAR
MBBS

MS
DLO
OTHERS

5. MEDICAL COUNCIL REGISTRATION NO., DATE & STATE :
   
 
6. PRACTICE : Limited to otolaryngology
  With other Branch of Medicine

7. PRESENT HOSPITAL or COLLEGE ATTACHMENT

 
8. MEMBERSHIP OF OTHER PROFESSIONAL SOCIETIES :
    i)
   ii)
  iii)

9. MEMBERSHIP OF REGIONAL AOI BRANCH

10. IF YOU WERE A MEMBER OF THE ASSOCIATION PREVIOUSLY YOUR MEMBERSHIP NUMBER WAS

I declare that the above information is true to the best of my knowledge.

Dated :


PROPOSED BY

NAME OF THE MEMBER MEMBERSHIP No.
  i)
 ii)
 

RATES OF SUBSCRIPTION WITH EFFECT FROM 1ST APRIL 1994

Type of Membership

Subscription

Total
ORDINARY MEMBERSHIP (INDIAN)

Rs. 375 (yearly)

 Rs. 375
LIFE MEMBERSHIP (INDIAN) Rs. 750 Rs. 750

PLEASE SEND YOUR FEE BY DEMAND DRAFT ONLY IN FAVOUR OF:
THE ASSOCIATION OF OTOLARYNGOLOGISTS OF INDIA. TO THE TREASURER. PLEASE DO NOT SEND MONEY ORDER OR PERSONAL CHEQUES.

The first copy of the Indian Journal of Otolaryngology and Head & Neck Surgery will be dispatched after 4 to 5 months from the date of receipt of the subscription, by our Calcutta Journal Office.

Please inform any change in your mailing address to the Honorary Secretary, Editor of the Journal and Organizing Secretary of the Annual Conference of AOI.
 
ELIGIBILITY :
ORDINARY MEMBERSHIP: Registered Medical Graduate of MODERN MEDICINE with practice AND LIFE MEMBERSHIP limited to Otolaryngology or with other speciality.
 
 
 

THE ASSOCIATION OF OTOLARYNGOLOGISTS OF INDIA
BIHAR & JHARKHAND STATE BRANCHES
2001-2002
Reg. No. 586
President
Dr. J.P. Mukherjee
Karmic Nagar, Dhanbad
Ph: 0326-202018

Vice President
Dr. CHANDRASHEKHAR		 Hony. Secretary
Dr. RANBIR K. PANDEY
53, Vaibhav Apartments
Budha Marg, Patna–800 001
Ph: 0612-228141 (R)
0612-234499 (O)
E-mail:
ranveerdoc@yahoo.com
dr_rkpandey@indiatimes.com
President Elect.
Dr. B.P. Saha
(Patna)
 
 
Immediate Past President
Dr. (Col.) P. N. Singh
(Purnia)
 
Hony. Treasurer
Dr. P.K. Singh
(Ranchi)
 
Joint Secretary
Dr. Manoj Kumar Verma
(Gaya)
 
Dr. B.K. Singh
(Purnea)
 
Member’s Executive Body
Dr. G.R. Prasad
(Bokaro)
 
Dr. Amar Singh
(Jamshedpur)
 
Dr. Devenderjee
(Jamshedpur)
 
Dr. A.K.Thakur
(Dhanbad)
 
Dr. U.N. Jha
(Madhepura)
 
Dr. A. K. Anil
(Siwan)
 
Dr. Manoj Kumar
(Patna)
 
Dr. R.P. Thakur
(Gaya)
 
Dr. N.K. Singh
(Danapur)
 
Dr. Surendra Pd. Singh
(Bhagalpur)
 
Editor-BJORL
Dr. Raghaw Sharan
(Ranchi)
 

XXVI Annual State Conference 2002
at Jamshedpur, Jharkhand
 

55th AOICON – 2003, PATNA
2003 JANUARY 9-12th.
 
 
 
 
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