AOIHO

Title

FIRST NAME *

MIDDLE NAME

LAST NAME *

NAME IN FULL

DATE OF BIRTH

Address

City*

State*

Country

Pin Code

Mobile No *

Email Id *

QUALIFICATION (Copies of certificates to be attached)

DEGREE/DIPLOMA	UNIVERSITY	YEAR OF PASSING	UPLOAD DOCUMENT
MBBS
MS
DLO
OTHERS

State Medical Council Registration No. *

PRACTICE:

1. LIMITED TO OTOLARYNGOLOGY:

2. OTHER BRANCH OF MEDICINE:

PRESENT HOSPITAL OR COLLEGE ATTACHMENT

MEMBERSHIP OF OTHER PROFESSIONAL SOCIETIES

MEMBERSHIP OF REGIONAL/ STATE/ CITY AOI BRANCH

I DECLARE THAT THE ABOVE INFORMATION IS TRUE TO BEST OF MY KNOWLEDGE.

PROPOSED BY:

	AOI LIFE MEMBER	MEMBERSHIP NO.	CONTACT NO	MAIL ID
1.
2.

Type of registration

Life Membership (Indian)

Life Membership (Foreign)

REGISTRATION FEE

For Indian participants in INR and Foreign participants in US$ - including GST
Registration fee for Indian participants applicable only for Indians working and residing in India

Registration Category19-04-2025	Membership Fee
Life Membership (Indian)	₹10000
Life Membership (Foreign)	$500

Register Member