Neurovascular Interventions Society of Indraprastha

Membership Type:

Payment Details:

Associate Membership (3 Years) – ₹3,500

Associate Membership (5 Years) – ₹5,000

Full Life Membership – ₹12,000

Name in Full:

Date of Birth:

Sex:

Address with Pin Code:

Telephone No.:

Mobile No.:

Email:

Qualification:

No. of Years in Neuro Intervention Practice:

Percentage of Practice in Neuro Intervention (%):

No. of Diagnostic Procedures (last 1 year):

No. of Therapeutic Procedures (last 1 year):

Hospitals / Institutes Attached:

I hereby declare that the information provided is true.

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