Download Registration Form

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

Address (Company)

Address Line1
Address Line2
Address Line3
City
State
Pincode/Zipcode
Phone Number

Address (Residential)

Address Line1
Address Line2
Address Line3
City
State
Pincode/Zipcode
Phone Number
Please Provide address of Office or Residence for Communication *
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. Life Membership (LM) 5,000 300
5. Paramedics Membership (PM) 2,000 300
6. Students Membership (SM) 1,200 300
Note: Head of the Department (HOD)/ Principal/ Registrar/ Dean/ Director CERTIFICATE of Proof of
Studentship with the Letter Head & Signature along with Official Stamp.
7. Overseas Institutional Membership (OVIM) $ 1,000 If transferred through bank $ 5 to be added
8. Overseas Membership (OVR) $ 200 If transferred through bank $ 5 to be added
9. SAARC Countries (SAARC) $ 125 Including Application
Processing Fee
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:
 
I read the Telemedicine Society of India's Bylaws and I will abide the same once I become a member.