Full Name
Age
Gender MaleFemaleOther
Qualification
Current Professional Affiliations Address
Residential Address
Mobile Number
Email
Category of Membership Applied For Life Full Member (₹12,000 Inclusive GST)Associate Member (₹8,500 Inclusive GST)
Proposed By
Proposer Signature
Seconded By
Seconder Signature
Upload Required Documents (Aadhar / ID Proof, MBBS Degree, PG Degree, Medical Registration Certificate)
Upload Payment Proof (Screenshot / Receipt)
Declaration [acceptance* declaration] I hereby declare that I agree to abide by the rules and regulations of Delhi Psychiatric Society.
Date
Please submit the completed application form to the Treasurer, Delhi Psychiatric Society (Dr. Ashwani Kumar).
Membership fee details (inclusive of GST):
Life Fellow Member: ₹12,000
Associate Member: ₹8,500
Payment should be made via Cheque or Online Transfer to the Delhi Psychiatric Society account.Kindly share/upload a copy of the payment details.
Bank Details:
Bank: ICICI Bank
Account No.: 008701033829
Branch: Janakpuri, New Delhi
IFSC Code: ICIC0000087
Please attach self-attested copies of the following documents:
Aadhar Card or valid ID Proof
MBBS Degree
Post Graduation Degree
Medical Registration Certificate