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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 *
Blood Group *
 
Email Id *
Email Id will be used as Username
Password *
Confirm Password *
 
Upload Photo * Good PASSPORT STANDARD PHOTO for ID card. Only jpg files are allowed.
Photographs that do not show the full face or not of passport standard will be rejected.

आईडी कार्ड के लिए अच्छा पासपोर्ट मानक फोटो। केवल jpg फाइलों की अनुमति है तस्वीर जो पूर्ण चेहरा नहीं दिखाते हैं या पासपोर्ट मानक का अस्वीकार कर दिया जाएगा। (File Size Max 10MB)
   


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)
City branch options must be corresponding to Current or Permanent address.
If opted otherwise, admin will change your City Branch to the branch in the area of Permanent address.

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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