Apply Membership – FOBO-India

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Middle Name

Last Name

E-mail Address*

Mobile Number*

Password*

Confirm Password*

Address*

City

Birth Date*

Passing Year (First Graduate Degree)*

Post Graduate degrees (Multi Select)*

Phd or Others specification

State Medical Council Registration Number*

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Experience*

Proposer required for less than 5 years experience

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Proposer Info (Mobile, E-mail, Designation)*

Life Membership Fees
Patron - Rs.10,000/- 
Member - Rs. 5,000/-

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