Indian College of Anaesthesiologists (ICA) , Institute of Anaesthesiology, Pain & Perioperative Medicine,Sir Gangaram Hospital, New Delhi-110060 India

JOIN OUR MEMBERSHIP TO GET MORE BENEFITS

Join Now

Fees to be paid Rs. 5,000
ICA Bank A/C details
Bank Name: Canara Bank
Branch: Sir Ganga Ram Hospital Branch, New Delhi
Account No.: 90682010102608
Name: INDIAN COLLEGE OF ANAESTHESIOLOGISTS
Type of account: Saving Bank
IFSC code: CNRB0019111
Branch Code: 19111
MICR Code: 110015465

Payment for foreign delegates,
Associate membership for a period of 3 years:
200 USD for Foreign delegates
100 USD for Southeast Asian countries
For Foreign Candiadate Swift Code : CNRBINBBBFD

First Name *

Surname*

Email*

Phone no*

Date of Birth*

Qualification*

Experience

Diploma in Anaesthesiology/ MD in Anaesthesiology/DNB in Anaesthesiology/ Fellowship/Other qualification’s in Anaesthesiology

MBBS In Year*

Institution Detail

Institution Name:*

Address *

Course*

Year of completion*

Designation

Address

Place of Work - Institution

Place of Work - Hospital

Permanent Address*

zip code / pin code

Country*

State*

Mailing Address*

Detail

ISA Membership No

Sister Anaesthesia Association Membership No

Name of Association

Medical Registration No.–MBBS*

Registration No. PG(DA/MD/DNB)*

State where Medical qualifications registered*

Tel No: (Res)

Tel No: (Off)

Upload

Passport size photographs *

Copy of anaesthesiology qualifications (document) *

Copy of medical council registration (document) *

Payment Detail

Transaction ID/NEFT *

Date of Payment *

Interests *

Declarations

I would like to join as life member of Indian College of Anaesthesiologists and kindly grant me membership. I promise to promote the Indian College of Anaesthesiologists and will be actively involved in the activities of the college.