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Medical Membership Form

    Fill Head Office details

    Fill Educational Institution(s) details

    Whether a
    FirmSole Proprietary ConcernCompanyBody CorporateOther Body Engaged in EducationSocietyTrust

    Select Year of Establishment

    Name of the Authorised Representative(s) / Contact Person(s) (Not more than two)

    Name of the organizations / Chambers / Associations of which you are a member

    Members

    Membership Type as

    Duration

    Subscription

    Medical University / Institution

    Membership for 10 years
    Life Membership

    1,00,000/-

    Kindly acknowledge the sreceipt of the above and confirm our Membership.

    (Cheque / Demand Draft(s) may please be drawn in favour of "Education Promotion Society for India")
    Payment may please be made in favour of "EDUCATION PROMOTION SOCIETY FOR INDIA" OR be transferred/deposited in our

    Savings Bank Account No: 0629219 1018986,
    Bank: Oriental Bank of Commerce,
    Branch: Batra Hospital Branch, New Delhi,
    IFSC No: ORBC 0100629.