Membership Detals | Please contact us- +91 7012492925 , queries if any |
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Membership ID of the person you are referred by | |
Referee Name (Only existing members of society can refer) | |
Upload your Photo (Size less than 71KB) |
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Name | |
Name of Father | |
Gender | |
Date of Birth | |
Permanent Address | |
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Same as Permanent Address |
Address for Correspondance | |
email id | |
District |
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Mobile number | |
Proof of Identity |
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Selected ID Proof Numer | |
Upload your ID Proof (Size less than 300KB) (extension supported are .jpg .png) |
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SBI Collect Payment Reference | |
Payment Date | |
Amount Paid(excluding Bank Charges) | |
Qualifications | |
Occupation | |
Orgnization | |
Interest to work with HTSS Society |
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Area/areas of expertise in Healthcare Technology in details | |
DECLARATION |
- I unconditionally subscribe to the aims & objectives of the society and contribute towards attainment of the same.
- I will abide by the Byelaws of the society, as applicable and amended from time to time.
- I have not been convicted of an offence involving moral turpitude involving imprisonment.
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I agree. |
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