Medical Computer Society of India
A-113, Anna Nagar, 3rd Avenue, Chennai - 600 102, India
www.mcsindia.com   email : info@mcsindia.com
Tel : 044 - 26207000, 26263378/79  Fax : 044 - 26263477


Membership Form
(Please Fill in CAPITALS)
 
Full Name (Underline Surname) :  
Date of Birth :  
Sex :      Male / Female
Qualifications :  
Address for Correspondence :  
Telephone - Hospital / Office :                           Fax No. :
E-mail Address :  
Name and Address of Hospital / Company / Institutions :  

Areas of Interest (Please Tick One or More)
1. Medical Education 2. Telemedicine
3. Hospital Management Information System 4. IT Healthcare Security / Legal issues
5. Health portals 6. EMR
7. Imaging Solutions 8. Healthcae Business Solutions
9. Medical Transcription / Call centers 10. Others (Please Specify)

Membershp Category (Please Tick One)

Type of Membership

 Indiividual Organisations / Corporates (Upto 3 Nominees)
2 Years Rs. 500/- Rs. 2000/-
5 Years Rs. 1000/- Rs. 3500/-

(Make Cheque / Bank drafts payable to "MEDICAL COMPUTER SOCIETY OF INDIA" & send it to the above address. List two Referees for your membership with addresses / Telephone Nos and e-mail addresses at the back of this form, otherwise membership will not be considered)
I will abide by the rules and regulation of the society, if i fail to do so or if do not pay my outstanding dues to the society my membership may be cancelled at any time.

 

Place :
Date :                                Signature
(Please note you will receive an intimation of your membership status within three to four months of your application)

 

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