APASO | Andhra Pradesh Association of Surgical Oncology

Personal Details

First Name *

Last Name *

Email *

Mobile Number *

Date of Birth * Format: DD/MM/YYYY

Communication Address

Address *

State *

City *

Pin Code *

My communication address is different from Permanent address *

Yes (Same Above)

No (Different)

Professional Details

Medical Registration Number *

State of Registration *

Current Affiliation

Qualifications

MBBS (College/University)

Year of Passing

MS/DNB (College/University)

Year of Passing

Any other Super Speciality

Year of Passing

Experience in Surgical Oncology

References

Reference 1

Name *

APASO ID

Mobile Number

Email ID

Reference 2

Name *

APASO ID

Mobile Number

Email ID

Payment: â‚¹5000

UPI ID: 9042092936@sbi

Scan & Pay â‚¹5000

Bank Transfer Details

Account Name
AP Association of Surgical Oncology
Account No
43816463612
IFSC Code
SBIN0017800
Bank
State Bank of India
Branch
PBB Branch

Document Uploads (All Required | Max 5MB | JPG/PDF only)

1. Medical Registration Certificate * JPG or PDF, Max 5MB

2. MCh/DNB Surgical Oncology Certificate * JPG or PDF, Max 5MB

3. Passport Size Photo * JPG only, Max 5MB

4. Payment Proof (UPI/Bank) * JPG or PDF, Max 5MB

Life Membership Application Form

Permanent Address

Qualifications

Reference 1

Reference 2

Bank Transfer Details