APPLICATION FOR MEMBERSHIP

Any queries regarding Online Registration Technical Assistance, Please contact 0824 – 4252005 ( 9:00 AM – 6:00 PM Working days)
Any queries regarding Registration Fee, Membership Number etc.
   How to apply at Online Membership Application
'*' Fields are Mandatory
Membership Type :






* Select Prefix :

* Name :

* Name of College/Place of Work :

* Photo : (Photo Size Max 1MB)



* Upload Scanned Copy of Payment Receipt : (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 :

* DOB :
 

* 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 :

* Select your state for State Membership :

Payment Mode :

To View Membership Amount Click here :

Payment Details
* Amount Paid :

* Date :


* NEFT Transaction Number :
* A/C Holder Name :

* A/C Number of A/C Holder :

* Bank :
* Branch :

Please click on Submit button

Following Key Contact

President
DR. VEERABAHU. M.
Phone : +91 9840141824
Email : president@aomsi.com
Hon. General Secretary
DR. PRITHAM N SHETTY
Phone : +91 9008400200
Email : secretary@aomsi.com
Hon. Treasurer
DR. PRAMOD SUBASH
Phone: +91 8281022999
Email: treasurer@aomsi.com
Hon. Editor
DR. RISHI BALI
Phone : +91 9315396704
EmaI: editor@aomsi.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
Swift Code : SBININBB

Mail

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

Mail Address
secretary@aomsi.com