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Institution / Corporate name *
Head of Institution / Corporate Name *
Designation *
Date of Inception
Contact Person *
Designation *

Please Provide Address of Institution / Corporate for Communication

First Line
Second Line
Third Line
Phone Number
Country *
Mobile *
Alternate Phone
Email *
Proof of ID PAN Card Aadhar Card
Pan Card Number *
S.No Membership Type Fees in INR Application Processing Fee
1. Corporate Membership (CM) 1,00,000 300
2. Startup Corporate Membership (SCM) 50,000 300
3. Institution Membership (IM) 25,000 300
4. Overseas Institutional Membership (OVIM) $ 1,000 If transferred through bank $ 5 to be added
Payment Type Online NEFT/DD / Cheque
Payment Detail: Drawn in favour of “Telemedicine Society of India” Payable at Lucknow along with Bio-Data / CV. For Online Transfer at State Bank of India”, IFSCode: SBIN0007789; TSI A/C No. 33659660395

NEFT/DD / Cheque No:
Name of Bank:
I read the Telemedicine Society of India's Bylaws and I will abide the same once I become a member.