UP Chapters of Obstetrics & GynAecology Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Dear Madam/SirI here apply to be enrolled as a life Member of the U.P. Chapter of Obstetrics & Gynaecology.Father's/Husband/Wife NameCurrent AddressPermanent Address Contact InformationContact DetailsEmailQualificationQualificationUniversityYear of AdmissionYear of PassingLayoutRegistration NumberName of Council RegistrationLayoutAre you in service?YesNoChoose MembershipLife Membership + Journal for 3 years =(5000+1500=6500)Annual membership + journal = (1500+500=2000)Upload Screenshot of Payment Click or drag a file to this area to upload. StatusGPConsultant Hospital PracticesPaymentPaid OfflineLayoutPayment DetailsTotal AmountTotal AmountBank Txn/Ref No.DateTotal Amount (copy)Total Amount (copy)Total AmountBank Txn/Ref No.DateSubmit
