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APPLICATION FOR ASSOCIATE MEMBER

ONCOLOGICAL SOCIETY OF BENGAL

ONLINE APPLICATION CHARGE BREAK-UP

ASSOCIATE MEMBER APPLICATION FEES : ₹ 2,500 + Payment gateway charge

PAYMENT GATEWAY CHARGE : ₹ 61.00

TOTAL : ₹ 2,561

ASSOCIATE MEMBER APPLICATION FORM

Please fill up all the details carefully. Upon successful submission you will be redirected to our payment gateway.

Surname (required)

Name (required)

Date of Birth (required)

Sex (required)
MaleFemale

Nationality (required)

Present Designation (required)

Medical Registration No (required)

Hospital / Office Address (required)

Permanent Address (required)

Mobile No (required)

Phone No

Email Id (required)

Fax No

Discipline (required)
RadiotherapySurgical OncologyMedical OncologyHemato-oncologyRadiologyOncopathologyPalliative careOther

You are applying for
Associate Member

( Please attach a separate sheet, if reqd. Max filesize: 5MB)

Please upload your passport size photo (Max: 2MB) (please upload only jpg, png or gif)

I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I undertake to inform you of any changes therein, immediately.

IMPORTANT LINKS

BENGAL CANCER SUMMIT 2023 REGISTRATION

PAYMENT PARTNER

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