Membership Form

Your Name (required)

Date of Birth (required)

Sex
—Please choose an option—MaleFemaleOthers
Address for Correspondence (required)

Permanent Address (required)

Qualifications (required)

Current Designation (required)

Your Email (required)

Proposed by: Dr.

Seconded by: Dr.

Aadhar Number/ Passport Number (required)

Registration No. and Council (required)

Please upload the following documents with your application:

1. Scanned copy of the Completed application form (along with signatures of Proposer and Seconder)

2. Self attested Copy of MCh/DNB/FRCS/equivalent (Plastic Surgery) degree certificate

3. Self attested Copy of the updated registration certificate of the concerned State Medical Council

• Application for associate membership must be accompanied by a letter from the head of the department of plastic surgery/supervisor (preferably an existing member of the APSWB)
4. Evidence of online payment of requisite fee (Rs 5000 for Member and Rs 2000 for Associate Member) to APSWB account no. 005010100007579 in Axis Bank Shakespeare Sarani Kolkata 700071

5. * Mail all the documents to secretaryapswb@gmail.com

I agree to abide by the Rules and Regulations of the APSWB