Poona Surgical Society

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Payment Details

Please pay Rs. 5000/- towards Life membership of the Poona Surgical Society.The payment to be made by:

1. Demand draft /Cheque drawn in favour of
“Poona Surgical Society”
payable to Treasurer, PSS

Treasurer: Dr. Bharat Dikshit

2. Online fund transfer to:-
Account Name:- Poona Surgical Society
Bank name:- HDFC Bank
Branch name:- Aundh
Account no.:- 59200000022111
IFSC code:- HDFC0003981
Account Type: Current

Membership Form

Title *
First Name * Middle Name Last Name * Date of Birth *

Upload Member Photo * (JPG / JPEG / PNG / PDF Upto 2 MB only)

Highest Qualification *

Upload Qualification Certificate * (JPG / JPEG / PNG / PDF Upto 2 MB only)

Specialty *
Medical Council Registration Number * Address
Address Line 1 *

City *

State *

Postal Code *

Country *

Upload Residence Proof * (JPG / JPEG / PNG / PDF Upto 2 MB only)

Mobile No. * Alternate Mobile No. Email Id * Alternate Email Id. Other Contact No.

Payment Details
Mode of Payment *

Cheque / DD

Online