Member Registration

Membership Registration Application

Personal Details

Name *

Father's Name / Husband's Name *

Gender *

DOB *

Age *

OCMR / SMR / IMR Registration No *

Email *

Contact No *

WhatsApp No *

Address Details

Permanent Address

Current Address Same as Permanent Address

At *

Post *

PS *

State *

DIST *

Pincode *

Occupational / Professional Details

Desigantion *

Select Institution *

Name of the Institution / Organaization *

Department *

Date of Joining in Service *

Date of Superanuation *

Present Place of Posting *

Name of The Dist (Where Place of Posting is Coming Under) *

Marital Status

Upload Relevant Documents / Information

OMES / VIMSAR Appointment ORDER (only PDF)

Aadhar Card (only PDF)

Photo (only JPG)

Declaration

1. I do hereby declare that the information furnished by me in this format are genuine and if, at any time in future the same will be found forged or manipulated in any manner, that I will be held liable for the consequences as per the decision taken by the Association.
2. I hereby agree to be the bonafide member of the Odisha Medical College Teachers' Association.
3. I further agree to pay the annual membership fee and abide by all the existing rules and regulation which may be prescribed by the Association from time to time.