Registration

(Please write your name in capital as it willbe printed on your certificate & badge)

First Name* *

Surname* *

Age* *

UG Degree/College* *

PG Degree/College*

Any Additional Degree/Fellowship*

Rajasthan Medical Council Number (UG/PG)*

Other Medical Council number (UG/PG)*

Present Designation* *

Work Place* *

Permanent Address* *

Address for the Correspondence* *

Phone numbers (Residence/office/Mobile)* *

E-mail id* *

Social Media Handles*

AOI National Membership no*

BANK DETAILS
Account Name : ALUMINI SOCIETY OF OTOLARYNGOLOGIST OF INDIA (AOI)
A/c No. : 2081220726400428
Bank Neme: AU small finance bank limited
IFSC Code : AUBL0002207
Please deposit Rs 5000/- as the membership fee to the following account & mail the receipt at “secretaryaoirajasthan@gmail.com”