Associantion of Physicians, Nashik

Associantion of Physicians, Nashik

Yearly Membership Application

MMC Regn
Name Last First Middle
Degree
Date of Birth / DD / MM YYYY

Mobile Number
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Landline Number
Email

Web Site
DD/cheque Amount of Rs. 2000 + Rs. 360 (18% GST) = Rs. 2360 for 2020-21 & 2021-22
should be in Favour of Association of Physicians, Nashik

OR
You can deposit or NEFT the amount in favour of:
Account No.: 60044032456

Bank Name: Bank of Maharashtra

Account Name: Association of Physicians, Nashik

IFSC No.: MAHB0000672