(Society Register No. 1214 Public Trust Reg. No. F/21368, Mumbai)
Affix Stamp Size Recent Colour Photo 2.5cm x 3cm
For Office Use only
Ac / As ; L / O ; _____ / _____
Admitted on ___/____/_______
Application for Membership (Please type or write in capital letters)
1. I, Dr./ Mr./ Ms.___________________, _____________________________________
(Surname) (First name) (Middle name)
wish to apply for Active / Associate, Life / Ordinary membership of the ISOI,
Referred By __________________________________________________________
I would like to have my name to be printed on the Membership Certificate as : ______________________________________________________ 2. My address is
Annual Membership (from April to March valid for one year only. Fees are payable for the full year irrespective of the month of joining)
Student Membership (from July to June valid for one year only. Fees are payable for the full year irrespective of the month of joining)
* Please add Rs.200 for Outstation Cheques
Enclosed Rs. / USD ___________ in cash / by cheque / by demand draft no. _____________,
dated _________, drawn on ____________________________________________________
______________________ Branch in favour of “Indian Society of Oral Implantologists” payable in Mumbai.
You can deposit cash or cheque in the ISOI account at any branch of the Bank of Maharashtra or you can send online payment as per the following Bank details. Please send us zerox copy of the deposit receipt or payment details via email or with membership application form.
Application approved / rejected at Executive Council Meeting held on _______________
Receipt no. ______________ issued on _______________
(Hon. Secretary) (Hon. Treasurer)
1) Active member: - The applicant should hold atleast a B. D. S. degree from any University in India recognised by the Dental Council of India and should produce documentary evidence that he / she has attended atleast one training course in Oral Implantology in any system and / or has some background in Implant practice.
2) Associate member: - Associate membership is open to Dental Laboratory technicians, Dental Hygienists, Dental / Implant manufacturers & dealers, Physicians, Surgeons & Research Personnel.