Indian Medical Association Calcutta

Request to Members

Members are requested to send their subscription within 31st, December 2005, otherwise the subscription will be increased for 1st January, 2006.

Members are requested to enrole at least one New Member

Please fill up the following proforma and send to our office to up date our records

Name (required):

Date of Birth / Age

DD: MM: YY:

Residence Address:

Chamber Address:

Telephone(Residence):

Telephone(Chamber):

Mobile No:

Fax No.

e-Mail:

Enter your Speciality