Membership

Title

Name

Gender

Male

Female

Present Designation

Hospital/Clinic Details

Address

State

Pincode

Telephone (with National & Local STD code)

Facsimile

Residential Details

Residential Address

State

Pincode

Telephone (with National & Local STD code)

Facsimile

Email Address

Medical Registration Details

Registration No:

Date of Registration

Place of Registration

Tertiary/Higher Education

Institution

Qualification(Bachelor's Degree/Postgraduate Course)

Reasons for joining DFSI

We do diabetic foot work, hence desire to be a part of DFSI

Want to learn more about Diabetic Foot

As part of Conference Organizing Committee

Any Other

Memberships of other professional organizations (if any)

Honours and Awards (if any)

Upload Certificate

Upload Photograph

Upload Signature

Note: If you are a person trained in Allopathic Medicine you are required to pay Rs 10000/- for the life membership which is the only option for allopaths. All others are associate members and will pay only Rs 1500/- for their life membership. This distinction is on account of the associated members NOT having any voting rights which the Allopaths have. Nor can the new associate members have the right to run for the Executive Committee posts. Tick as applicable.

Membership Plan

Rs 10000/- 5 Years Membership

Rs 5000/- 5 Years Membership for Non-Allopaths

Enter Code

Institution

Qualification(Bachelor's Degree/Postgraduate Course)

Become a Member

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