Membership Form

Membership to Indian Ophthalmology Forum is free and is available to all ophthalmologists. After an initial screening the membership will be confirmed and the name and details of the member will be added to the members directory. Fill up all the details before submitting the form.

Name (first):
Name (Middle):
Name (last):

Age (in years): Sex: Male Female

Address:

Phone: Fax:

E-mail:

Qualifications: MBBS; MS/MD; DO; DNB; FRCS/Ophth;
Others
(Check all the qualifications you possess).

What is your sub-specialty?

What is your professional position? Private Practice Government Job Student

Name of the Institution/Clinic/Hospital

Address (office):

Phone (office): Fax:

Any other detail about yourself which you would like us to know:

Please read again carefully before submitting the form.

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This page was last edited on 21 May, 1998 by Dr. Sanjay Dhawan. To contact the editor click here!