ITS Member Registration

Full Name:*

Specialty:*

Qualification:*

Email Id:*

Mobile:*

Address:*

Payment Type : *

Cheque Demand Draft NEFT/RTGS Swift

Currency: *

Amount: *

Cheque No: *

Bank Name: *

Branch Name: *

Upload Scanned copy of Cheque:

* Max file size allowed is 2MB.
* Only .jpg and .png file format is allowed.

Currency: *

Amount: *

Account No: *

Bank Name: *

Branch Name: *

Account Holder Name: *

Transaction Id: *

Transaction Date: *

Upload Scanned Copy of Receipt of Electronic Transfer:

* Max file size allowed is 2MB.
* Only .jpg and .png file format is allowed.

Note:-

Please pay Rs.2950/- (2500+450 -18% GST) towards Life membership of the Indian Thyroid Society. This includes life subscription to the journal ‘Thyroid Research & Practice’. The payment to be made by:

1. Demand draft /Cheque drawn in favour of “Indian Thyroid Society” payable at Cochin.Send draft / cheque to following address:

Dr. P. K. Jabbar
Department of Endocrinology
Government Medical College
Trivandrum, Kerala – 695011

2. Online fund transfer to:-
Bank name:- Dhanalaxmi Bank
Branch name:- Edappally Branch, AIMS Ponekkara P.O, Kochi-41
Account No:- 015501400001584
IFSC code:- DLXB0000155.

ITS Member Registration

Full Name:*

Specialty:*

Qualification:*

Email Id:*

Mobile:*

Address:*

Payment Type : *

Currency: *

Amount: *

Cheque No: *

Bank Name: *

Branch Name: *

Upload Scanned copy of Cheque:

Currency: *

Amount: *

DD No. *

Bank Name: *

Branch Name: *

Upload Scanned copy of DD:

Currency: *

Amount: *

Account No: *

Bank Name: *

Branch Name: *

Account Holder Name: *

Transaction Id: *

Transaction Date: *

Upload Scanned Copy of Receipt of Electronic Transfer: