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Application for Membership











    I certify that the statements made by me in this form are true, complete and correct.I understand that any false statement may provide grounds for cancellation of membership from the association.
    Upload Your Signature (.jpg,.png,.jpeg) file format

    Note:
    Only dermatologists with a DVD/MD/DNB degree are eligible for life membership on payment of fees. Please send a Demand Draft of Rs. 20000/- payable to “Indian Society for Paediatric Dermatology”. Payment from outside India must be made by draft for $350 US dollars payable at Kolkata, India.

    INDIAN SOCIETY FOR PEDIATRIC DERMATOLOGY A/C NATIONAL CONFERENCE

    Account No : 915020011132474
    IFSC code: UTIB0003067
    Bank: Axis Bank
    Branch: Delta colony
    Bhubaneswar, Odisha

    Mail completed application with remittance to:
    Dr. Maitreyee Panda
    Honorary General Secretary
    Neev child and Skin Care
    Indradhanu Market, IRC Village, Nayapalli,
    Bhubaneswar, Odisha 751015.
    E-mail: pandamaitreyee@gmail.com

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