Membership/ Registration

Download Registration Form

Name *
Father/ Spouse Name *
Qualification *
Gender *
Date of Birth
Contact Person *
Designation *

Address (Residential)

Address Line1
Address Line2
Address Line3
City
State
Pincode/Zipcode
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. Life Membership (LM) 5,400 -
2. Associate Membership (AM) 5,400 -
3. Paramedics Membership (PM) 1,980 -
4. Students Membership (SM) 1,350 (For 5 Years) -
Note: Head of the Department (HOD)/ Principal/ Registrar/ Dean/ Director CERTIFICATE of Proof of
Studentship with the Letter Head & Signature along with Official Stamp.
5. Overseas Membership (OVR) $ 180 If transferred through bank $ 5 to be added
6. Overseas Institutional Membership (OVIM) $ 900 If transferred through bank $ 5 to be added
7. SAARC Countries (SAARC) $ 112 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:
Date:
Name of Bank:
Branch:
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I read the Telemedicine Society of India's Bylaws and I will abide the same once I become a member.