PESI-IAPS online membership form
(please use this form to apply for PESI membership. Please make sure you have read the membership terms. You will get a copy of this form in your mail inbox. Please print, sign the form and attach a passport photo and send to PESI Secretary. The process will be complete once the hard copy is received
Email address *
E-Mail *
Please re enter email address
Type of membership you are applying for *
Full Name *
Date of Birth *
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DD
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IAPS Membership no *
(please note that it is a mandatory requirement to have IAPS membership. You are eligible to apply if you are in "applied for" status with IAPS. Please write applied in such case)
Present Affiliation
Area of interest in Pediatric Surgery
Qualifications *
please write about your MBBS/MS/MCH/other degrees with name of institution & year of passing
Residential Address *
with PIN code
Office address
Telephone no *
please provide your mobile no with country code
Details of membership fees *
please enter the reference no of payment made. The bank account details are Account Name - PESI-IAPS A/c No 35508915934 Bank name SBI (Textiles branch Batala road Amritsar Punjab) Branch Code 50644 IFSC CODE - SBIN0050644
Member Recommendation *
Please give name and email of 2 existing PESI members recommending for your membership. PESI office will contact them for verification
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