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Membership Details
-- Category Applied For
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: (Add Rs 60 for outstation cheques)
Life Member(RS 4200)
Associate Life Member(RS 2100)
Corporate Life Member Indian(RS 50000)
Life Member (SAARC) (US $100)
International Life Member Excluding SAARC(US $200)
International Corporate Life Member(US $5000)
Mode Of Payment
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Draft
Cash
Name Of Bank
Chq/DD/Cash Reciept No
Cheque/DD/Cash Date
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Jan
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Please send the DD/Cheque in favour of
INDIAN SOCIETY OF CRITICAL CARE MEDICINE payable at MUMBAI
Percentage Of Time Spent in Critical Care
Speciality
*
0-25%
25-50%
50-75%
75-100%
Internal (General) medicine[Life Member]
Registered Nurse
Respiratory Medicine
Physiotherapist
Cardiology
Pharmacologist/Pharmacist
Surgery
BioMedical Engineer
Anaesthesia
Nutritionist
Paediatric
Others
References :
Name Of Member
Name Of Member
Email Id
Email Id
Membership No
Membership No
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