Tamil Nadu Ophthalmic Association
Membership Application Form
 
To

Dr.M.Radhakrishnan (Secretary)
Regional Institute of Ophthalmology and Govt Ophthalmic Hospital,
Rukkumani Lakshmipathi Salai,
Egmore,Chennai – 600 008

 
Dear Sir,
   
I hereby apply to be enrolled as Life Member of the Tamil Nadu Ophthalmic Association.
I am hereby enclosing herewith DD for Rs. 1550 drawn in favour of "Tamil Nadu Ophthalmic Association" payable at Erode
     
TNOA life Membership Fees Rs.
1500
 .00
Administration Charge Rs. 50 .00
Total Rs. 1550 .00
   
     
Signature of Applicant :
 
 
Please fill in Block Letters
 
Name    
Sex  
   
Age       
Date of Birth
     
Tel. No  
Email  

     

Communication Address
     
Qualification & University Name
       
Registration No. Name of council of registration
       
Proposed by Seconded by
       
Name Name
       
TNOA Mem. No TNOA Mem No
   
 

Download TNOA Membership Form
President / Secretary