KSOS Member Registration

All fields in application form are mandatory For Qualifications field (Medical), please enter the details of your Degree/Diploma ( minimum of one is mandatory)

Registration Type *:		Your Name *:
Father Name *:		Profile Image* :	[jpg,jpeg,png,gif] must be less than 2MB
Gender *:	Male Female	Date Of Birth * :
Mobile No * :		Email Id *:
Marital Status:		Aadhaar No * :
Medical Council Reg No * :		Year Of Registration * :
Name Of Medical Council * :		AIOS Membership :

Permanent Address

Address *:		Street Name *:
Country *:		State *:
City :		District :
Pin *:

Correspondence Address

Same as Permanent Address

Address *:		Street Name *:
Country *:		State *:
City :		District :
Pin *:

Qualification

Qualification *:		Institution Name *:
University *:		Year Of Passing *:
Enter More Qualification :
Qualification *:		Institution Name *:
University *:		Year Of Passing *:

KSOS Life Member who is proposing you for membership		KSOS Life Member who is seconding you for membership
Doctor Name *:		Doctor Name *:
MBBS Certificate*	[pdf, doc, docx] must be less than 2MB	Degree Certificate / Letter from HOD or Associate Member* :	[pdf, doc, docx] must be less than 2MB
Medical Council	[pdf, doc, docx] must be less than 2MB	Additional Qualification :	[pdf, doc, docx] must be less than 2MB
Note :

This is a staging enviroment