APPLICATION FOR MEMBERSHIP

Any queries regarding Online Registration Technical Assistance, Please contact 0824 – 4252005 ( 10:00 AM – 6:00 PM Working days)
Any queries regarding Registration Fee, Membership Number etc.
* Fields are mandatory    How to apply at Online Membership Application
 
Membership Type :

Select Prefix : *
Name : *
Name of College/Place of Work :
Photo
(Photo Size Max 1MB)  
:
Qualification :
Certificate
Graduadtion (BDS)*
(File Size Max 1MB)

Post Graduadtion (MDS)*
(File Size Max 1MB)

Others
(File Size Max 1MB)
Gender :
Correspondence Address : *
Pincode : *
Country : *
Select State : *
Correspondence Mobile Number [10 digit] : *
Correspondence Fax Number :
Correspondence Email ID  : *   
Residence Address  :
Pincode :
Country :
Select State :
Residence Contact Number :
Dental Council Registration Number :
Name of the State Dental Council :
Membership with other Professional Associations :
Payment Mode :
To View Registration Amount Click here : View Registration Amount

Payment Details

Amount Paid : *

Date :
NEFT Transaction Number : *
A/C Holder Name : *
Bank : *
Branch : *
 
 

Following Key Contact

President
DR. R.S NEELAKANDAN
Phone : +91 9444270020
Email : neelsomfs@gmail.com
Hon. General Secretary
DR. PRITHAM N SHETTY
Phone : +91 9008400200
Email : secretary.aomsi@gmail.com
Hon. Treasurer
DR. PRAMOD SUBASH
Phone: +91 8281022999
Email: aomsi.treasurer@gmail.com
Hon. Editor
DR. RISHI BALI
Phone : +91 9315396704
EmaI: aomsi.editor@gmail.com

Payment Information

NEFT

Or You can swift transfer through NEFT to below mentioned account details:

Bank Name & Address

State Bank of India
PONEKKARA BRANCH(18168)
36/1513A THEKKADATH COMPLEX,
POISHA ROAD, AIIMS P.O
ERNAKULAM DIST. - 682041
Account Name : AOMSI
Acc no. : 10301513020
IFSC Code : SBIN0018168

Mail

After the money is Deposited or Transfered kindly Mail the transaction details with scanned copy to

Mail Address
member.aomsi@gmail.com