PSS-Membership Form

Membership Form

How to Become a member

We thank you for your interest in becoming a member of Poona Surgical Society
Step 1: Fill the membership form given below. Please keep the following things ready-
1. Your Photograph (JPG / JPEG / PNG / PDF up to 2 MB only)
2. Medical Council Registration Number
3. Upload Qualification Certificate (JPG / JPEG / PNG / PDF up to 2 MB only)
4. Upload Residence Proof. Aadhar Card, Voter ID, Driving Licence, Utility Bill (JPG / JPEG / PNG / PDF up to 2 MB only)
Once the form is filled with all the details please check whether you have entered all details correctly before submission. Click the "submit" button to finish the process.
Step 2: Submission of application will redirect you to a payment gateway site. Please do not refresh the page. Transaction may take a few moments to process, and you should not interrupt the process by navigating away from the page.
Step 3: Completion of the above process will trigger an email acknowledging your application. This may take some time. Please also check your "Spam" or "Junk" folder(s). If you do not receive an email within a day or two, please contact our digital team at digitalhealth@cmplin.com. Thank you once again for your interest in PSS membership.

In case of any query please contact Secretary or Treasurer at psurgsoc@gmail.com.

Dr. Prafulla Tamaskar

Secretary, PSS

Dr. Mandar Doiphodee

Treasurer, PS

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*

Postal Code*

State*

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*

Online

Important Instructions:

Fill out the membership form accurately with valid information.
Membership form should be submitted only once.
Submission of application will redirect you a payment gateway site.
Please do not refresh the page.
Transaction may take a few moments to process, and you should not interrupt the process by navigating away from the page.
Failing to follow above mentioned instructions may abort successful submission of your application.