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Online Registration



Note: * Marked fields are Mandatory.     How to apply at Online Membership Application

BASIC INFO

Select Alphabet for your ISA No. *
 
Name *
 
Select Father/Husband *
 
Father/Husband Name *
 
Gender *    
Religion
Phone
Mobile Number *

Date of Birth *
Upload Photo * Good passport size color photo with Plain background required for ID card. Only jpg
files are allowed.(File Size Max 10MB)
   
Blood Group *
 
Email Id *
Email Id will be used as Username
Password *
Confirm Password *
 


ADDRESS

Current Address
DoorNo/House No/Flat No/Name *
 
Lane/Street/Village *
 
Area/Mandal/Land Mark *
 
State *
 
District *  
City *
 
Pincode *
 
Post Office

Permanent Address

DoorNo/House No/Flat No/Name *
 
Lane/Street/Village *
 
Area/Mandal/Land Mark *
 
State *
 
District *
 
City *
 
Pincode *
 
Post Office


MEDICAL COUNCIL

Name of Medical Council *
 
Medical Council Reg No *
 
Date of Registration *
Medical Council Reg No Valid Upto *


QUALIFICATIONS

Primary *
 
 
 
   

PG *
Select atleast one of these *
 

OTHER

Appointments
Special Interest
Remarks



PROPOSED BY / SECONDED BY

Note: Must be "Active Life Members (LM)" not Associate Life Members (ALM). If Verified then only you will be able to Register.

Proposer *
 
Proposed By (ISA No.) *
 
Seconder *
 
Seconded By (ISA No.) *
 

CLASSIFICATION

Note: If you have registered your PG Qualification with Medical Council, opt for Life Member (LM), PG students & others who have not yet registered PG Qualification, opt for Associate Life Member (ALM)

Life/Associate Life *
 
State Branch *
 
City Branch *
 

PAYMENT

Rs.7500/- Online Payment favoring "INDIAN SOCIETY OF ANAESTHESIOLOGISTS" OR "ISA NATIONAL" SBI Collect a/c (Current A/C) No. 35292412841, IFS Code SBIN0006715, payable at State Bank of India (SBI), Kasaragod Branch, Kerala (Branch Code 006715)

Payment Mode  
Transaction No *
 
Date *
Upload Scanned Copy * (File Size Max 10MB)      
Bank *  
Amount
Rs.7500/-

REMARKS

Remarks


If you are satisfied that all entries are correct and correct files are uploaded click here to register

REGISTER
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