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    This document is an application form for membership in the Cardiological Society of India Delhi Branch. It requests information such as the applicant's name, address, contact details, qualifications, experience, and preferred membership type (Life or Associate). The eligibility criteria and fees for each membership type are also provided. Applicants are asked to submit the completed form, copies of medical degrees and certificates of experience to the President or Secretary for review by the credential committee and executive committee.

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    This document is an application form for membership in the Cardiological Society of India Delhi Branch. It requests information such as the applicant's name, address, contact details, qualifications, experience, and preferred membership type (Life or Associate). The eligibility criteria and fees for each membership type are also provided. Applicants are asked to submit the completed form, copies of medical degrees and certificates of experience to the President or Secretary for review by the credential committee and executive committee.

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    39 views2 pages

    Csi Form Delhi

    Uploaded by

    cubadesignstud
    This document is an application form for membership in the Cardiological Society of India Delhi Branch. It requests information such as the applicant's name, address, contact details, qualifications, experience, and preferred membership type (Life or Associate). The eligibility criteria and fees for each membership type are also provided. Applicants are asked to submit the completed form, copies of medical degrees and certificates of experience to the President or Secretary for review by the credential committee and executive committee.

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    CARDIOLOGICAL SOCIETY OF INDIA     PHOTO  
    (Delhi Branch)
    Application for Membership 
    APPLYING FOR    Life membership Associate membership  
    (USE BLOCK LETTERS):

    Full Name ………………………………… …………………………………Date of Birth…………….……………………………………………………..

    Present Address………………………………………………………………………………………………………………………………………………….

    ………………………………………………………………………………………………………………………..PIN…………………………………………

    Permanent Address……………………………………………………………………………………………………………………………………………..

    ………………………………………………………………………………………………………………………..PIN….……………………..………………

    Tel :…………………..………………………………………………………………Mobile:………………………..…..…………………………………….

    E-mail…………………………………………………………………………………..……………………………….………………………………………….

    National CSI Membership Yes No, if yes, membership no…………………………………………….

    Qualification Year University

    Experience (In chronological order) (attach separate sheet if required):

    ELIGIBILITY CRITERIA FOR MEMBERSHIP:

    Life Membership: DM/ DNB Cardiology, MCh/ DNB Cardiothoracic Surgery, MD/ DNB (Medicine with experience in Cardiology), MRCP &
    FRCP with membership of National Body.

    Associate Member: Minimum qualification of MBBS.


    (Please send application with copies of medical degrees, certificates of experience signed by the relevant authority).
    MEMBERSHIP FEE:
    Life Member: Rs. 2,500/- Associate Member: Rs. 2,500/-
    Cheque/DD should be drawn in favour of “Cardiological Society of India Delhi Branch”, payable at Delhi
    PAYMENT INFORMATION:
    Cheque/ Demand draft no:……………………Date: …………………..Amount:………………….Bank name: ………………………………………
    OFFICE USE ONLY:
    Application received on: Final decision:: Accepted Rejected

    Recommendation from the credential committee: Membership no………………………………………………..

    Date of executive committee meeting: (Sign. of Secretary)

    Please return the completely filled form to:

    Dr. Rakesh Gupta Dr. Rakesh Yadav


    President CSI (Delhi Branch) Hony. Secretary
    Jrop Healthcare Pvt.Ltd. E-25, Ayur Vigyan Nagar,August Kranti Marg,
    C-1/16, Ashok Vihar, Phase-II, Delhi-110052. New Delhi-110049.
     
     
    Tel: 27415646, 27134839 Tel : 011-26263466
    Mob: 98110-13246 Mob: 98680-26888
    Email: jrop2001@yahoo.com / rakeshecho@gmail.com Email : rakeshyadav123@yahoo.com

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