Membership Form

Please fill the Membership application and make a Demand draft/Cheque of Rs.5000 (Rupees Five Thousand only) in favor of “Geriatric Orthopedic Society” payable at Bangalore and send it to the below mentioned address along with:

Certified copy of the PG degree/diploma

Certified copy of the Medical Council Registration

Direct NEFT - Transfers may also be made to the following account:

Account Name:	GOS
Bank:	Andhra Bank
Branch:	Bilekahalli, Bannerghatta Road
Account No:	119610100003730
IFSC Code:	ANDB 000 1196

Dr John Ebnezar, Founder President
Geriatric Orthopedic Society Of India
Working Office: Parimala Health Care Services, Bilekahalli, Bannerghatta Road,
Bangalore –560076. Karnataka, India
Phone: 080 - 26581231

FOR OFFICE USE ONLY:

Date of receipt of the application:

Registration Number:

Authorized signatory