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Please download the Registration Form and forward properly filled registration form along with relevant documents and payment to Secretary cum Treasurer.

Mail to:

Dr.V.Rangarajan
Indian Prosthodontic Society
Secretary cum Treasurer
230, Avvai Shanmugham Salai, 
Royapettah, Chennai - 600 014,
Tamil Nadu, India
Mobile  :  
91-94440 71871
Phone   :   044-28133186
Fax        :   044-28131094
E-mail   :   info@ipsonline.in  / secretary@ipsonline.in
                   president@ipsonline.in /
editor@ipsonline.in

Web      :   www.ipsonline.in

Payment Method

You have to make DRAFT / CHEQUE in favour of "Indian Prosthodontic Society" payable at CHENNAI, INDIA and send to the above address
or 
Deposit cash in our ICICI Bank Account, favouring "Indian Prosthodontic Society" payable at CHENNAI. Account No.602201201589

RTGS/NEFT/IFSC Code : ICIC0006022     ICICI
or
You can also make payment through Credit/ Debit cards

Note : For all online payments made through Credit, Debit and Master Card , a processing fee of Rs.450 will be charged.

Or 

Please Fill the below online Registration Form and submit the scanned copy of relevant supporting documents

INDIAN PROSTHODONTIC SOCIETY 
MEMBERSHIP FORM 

To, 
Dr.V.RANGARAJAN
Indian Prosthodontic Society
Secretary cum Treasurer

230, Avvai Shanmugham Salai,
Royapettah,
Chennai - 600014
Tamil Nadu, India

Dear Sir, 

I wish to became an Ordinary life member/ Student member of the Indian Prosthodontic Society and agree to abide by the rules and regulation of the society.

I am herewith enclosing the requisite amount Rs.  by Cash/Cheque/D.D. No dt.. as per details below together with my bio-data, copy of MDS degree (Prosthodontics) & DCI Registration Certificate duly attested by Gazetted Office and one passport size photograph on glossy paper.

Life Membership Fee     : Rs. 4,000.00
Entrance Fee (New Members)  : Rs. 500.00
TOTAL (including service TAx ) : Rs.5,060.00

NOTE: - 
1. Details to be filled in by the applicant in block letters only.
2. Cheque/DD to be drawn in favour of “INDIAN PROSTHODONTIC SOCIETY” payable at Chennai.
3. Please include Rs.50/- in case of Out-Station Cheque towards Bank Charges.
4. In Case of Ordinary life member, enclose copy of MDS degree (Prosthodontics) and Dental Council of India Registration Certificate duly attested by Gazetted Officer.
5. In case of Student members enclose copy of Dental Council Registration Certificate duly signed by Gazetted Officer and Bonafide Student Certificate attested by HOD Prosthodontics/ Principal.
6. Student Life membership will be converted to ordinary life member on submitting MDS Degree Certificate without additional payment.

Member Type :

Choice of Mailing Address :

RESIDENCE   OFFICE

LOGIN NAME :
PASSWORD :
CONFIRM PASSWORD :
FIRST NAME :
LAST NAME :
PRESENT POSITION :
DATE OF BIRTH : - mm/dd/yyyy format
DENTAL COUNCIL REGISTRATION NO :
STATE OF  :
OFFICE ADDRESS :
CITY  :
PIN  :
STATE :
TEL NO : --
ISD-STD-Phone No.
FAX : --
ISD-STD-Fax No.
EMAIL :
RESIDENCE ADDRESS :
CITY  :
PIN  :
STATE :
TEL NO : --
ISD-STD-Phone No.
MOBILE : -
ISD-Mobile No.
ALTERNATE EMAIL :
WEB :
EDUCATIONAL QUALIFICATION
DEGREE  INSTITUTE UNIVERSITY YEAR OF PASSING
B.D.S
M.D.S
Please attach your photo :
(Image size should be 150*80 and not more than 20 kb)

Other Information :

   Note : Once you filled the above form, online facility to submit your all relevant scanned Documents are
   provided. Kindly use it to send your documents safe and faster.

Indian Prosthodontic Society
Dr.V.Rangarajan
Secretary cum Treasurer,
230, Avvai Shanmugham Salai,
Royapettah, Chennai - 600 014, 
Tamil Nadu, India

 

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