Professional Info

Radiographers' Association Of Maharashtra : Membership Form

Shri Triloki Nath Mishra,
General SecretaryRadiographers' Association of Maharashtra,
Department of Radio- Diagnosis,
Tata Memorial Hospital,
Mumbai - 12.

Sub.: Membership of 'Radiographers Association Of Maharashtra'.

Sir,

I wish to join the Radiographers Association of Maharashtra ( RAM ) as a member. I hereby agree to abide all the rules and regulations of the same.

My details are as below

Your Name
Designation
Academic Qualification
Professional Experience (In years)
Name of the Hospital
Address of the Hospital (With Pin Code)
Residential Address (With Pin Code
Email ID
Date
Place
Payment Mode	Cash Demand Draft Cheque
Cheque / DD Number
Bank
Image Verification Please enter the text from the image: [ Refresh Image ] [ What's This? ]

Download the Form

Please print a copy of this form and send it with the payment alongwith the signature of head of the department, for purpose of verification.