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APPLICATION FORM FOR MEMBERSHIP OF INDIAN SOCIETY OF TRANSFUSION MEDICINE
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Title
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Dr.
Mr.
Mrs.
First Name
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Middle Name
Last Name
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Permanent Address
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City
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State
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--Select State--
Andaman & Nicobar Islands
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Dadra & Nagar Haveli
Daman & Diu
New Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu & Kashmir
Jharkhand
Karnataka
Kerala
Ladakh
Lakshadweep
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Punjab
Puducherry
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
Uttarakhand
Uttar Pradesh
West Bengal
International
Pin
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Correspondence Address
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Same as Permanent Address
Photograph (Image Format Only)
City
*
State
*
--Select State--
Andaman & Nicobar Islands
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Dadra & Nagar Haveli
Daman & Diu
New Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu & Kashmir
Jharkhand
Karnataka
Kerala
Ladakh
Lakshadweep
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Punjab
Puducherry
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
Uttarakhand
Uttar Pradesh
West Bengal
International
Pin
*
Office Tel. No.
Residence
Mobile No.
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E-Mail
*
Password
*
Date of birth
*
Nationality.
Gender
*
--Select Gender--
Male
Female
MBBS
*
DCP/DIBT
MD/DNB
Working in Blood Centre/Immunohematology
*
Professional positions held
Training / experience obtained in Transfusion Medicine (in India / Abroad)
Additional Information (Publications, Honours etc.)
LIFE MEMBER subscription:
Rs. 5,000/-
LIFE MEMBER subscription for Post Graduate students.
Rs. 3,000/- (To avail this opportunity, the completed New Registration Form must be accompanied with endorsement letter from respective Head Of The Department On Institutional Letterhead Format Attached)
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Note:
Payment for online membership registration once made will not be refunded.