Online Membership – Neurological Surgeons Society of India: (NSSI)

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Bank Details

Neurological Surgeons’ Society of India

NSSI Membership Application Form

Application for Membership

Name (Block Letters)

Date of Birth

Father's Name

Address

Address Line 1

Address Line 2

City

State

Phone No (With STD code)

Fax No

Mobile No

Qualifications and Institute

Appointments, Post and Experience

Other interest

Membership (Please select an appropriate option)

Date copy) Membership

Amount

D.D./Cheque at par No

Bank

In case of Electronic Money Transfer please quote UTR No (Attach a copy)

File Upload

Click or drag a file to this area to upload.

Payment can also be made by NEFT/Bank Transfer/IMPS. The detail are as follows: Bank ICICI Bank Branch C Scheme Opposite SMS Hospital Jaipur Account Holder’s Name: Neurological Surgeons’ Society of India. Account No 675001700384. MICR Code No 302229016. IFSC/RTGS ICIC0006750

Please attach you short cv

Click or drag a file to this area to upload.

Signature of Applicant

Clear Signature

Applicant' Photograph

Click or drag a file to this area to upload.

Acceptable CV File-size: Maximum 512kb OnlyAcceptable Filetype: Word or PDF Only

To Do Signature, Drag Mouse After Holding the Pressed Left Button of Your Mouse

Acceptable Photo size: 1Mb with 350 pixels (Width) X 350 pixels (Height)Acceptable Filetype: PNG, JPG, and JPEG Only

Place

Date

Life Member Rs.15000/- in one installment, Associate Member (DNB,MCh Students) 15000/- in one installment(Life Membership Reclassified after producing Degree/Diplome of MCh/DNB) Allied Member 10000/- in one installment, Foreign Members 400 USD to be drawn in favor of Neurological Surgeons Society of India. Dully filled membership application along with fee is to be sent to:-Dr. R.S.Mittal 105 Virndavan Vihar Colony Near Shyam Nagar Police Station Nirman Nagar Ajmer Road Jaipur 302019 Phone:-0141- 2810950,+919414244866(M) email dr_mittal@hotmail.com, nssi.india@gmail.com

Email Us Anytime

call us anytime

Bank Details

Neurological Surgeons’ Society of India

NSSI Membership Application Form

Payment can also be made by NEFT/Bank Transfer/IMPS. The detail are as follows: Bank ICICI Bank Branch C Scheme Opposite SMS Hospital Jaipur Account Holder’s Name: Neurological Surgeons’ Society of India. Account No 675001700384. MICR Code No 302229016. IFSC/RTGS ICIC0006750

Acceptable CV File-size: Maximum 512kb OnlyAcceptable Filetype: Word or PDF Only

To Do Signature, Drag Mouse After Holding the Pressed Left Button of Your Mouse

Acceptable Photo size: 1Mb with 350 pixels (Width) X 350 pixels (Height)Acceptable Filetype: PNG, JPG, and JPEG Only

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