ifs
Apply for FellowshipCovid-19 Guidelines
Home // Application for OSSI Endorsement

Application for OSSI Endorsement


Fields marked ( * ) are mandatory
  • Preferred Title :*
  • Family / Surname:*
  • First name:*
  • OSSI Membership No. :*
  • Gender :*

DETAILS OF THE INSTITUTITION:

  • Hospital:*
  • Designation:*
  • Address:*
  • Country:*
  • State:*
  • City:*
  • Pin:*
  • Tel. Office :* /
  • Mobile :*
  • E-mail :*
  • Website (if any):
  • COE No. if any:

DETAILS OF THE EVENT:

  • Title:*
  • Type:*
  • Date:*
  • Upload the Event tentative program:

[Note: Please upload doc, pdf, docx format only and file size not more than 4MB ]

DETAILS OF PAYMENT:

  • Endorsement Fee:*
  • Secure Code : refresh