Membership Registration Form

Registration Form
Membership Type:
New ApplicationRenewal Application
Date *
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Last Name *
First Name *
Middle Name
Your Email *
Mobile
Tel. Residence
Clinic *
Date Of Birth
Your Address
Qualification
College & university
Year of passing
Upload Certificate
MBBS
DGO
MD / MS
DNB
OTHERS
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MMC Registration No.*
N.B. FOGSI Category
N.B. FOGSI Category is as follows:

Category-A: Member with a Post Graduate qualification in Obstetic & Gynaecology Degree, Diploma, Membership or Fellowship.

Category-B: Non-Post Graduate members with MBBS qualification.
Payment Details
Amount*
Bank*
Branch*
Date*
Cheque / Draft No. / NEFT Transaction No.*
Secure Code*
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* Fileds are mandatory.
N.B.: Compulsory: Please note you have to submit the following attested certificates to POGS (Three copies each):
1) Undergraduate Degree
2) Post-Graduate Degree / Diploma
3) Photo 2 Nos.
Membership fee: Annual Rs. 1500/- (January to December)
Life: Rs. 20,000/-
Please add 18% GST in your membership.
Cheques may be drawn favoring: “PUNE OBESTETRIC & GYNAECOLOGICAL SOCIETY”
POGS Bank details for NEFT
Title of Account :
POGS
Name of Bank :
Bank of Maharashtra, Tilak Road Branch, Pune
A/C. No. :
00000060007236975
IFS Code :
MAHB0000100
Conference Secretariat: POGS office – 302/303, Dr Neetu Mandke IMA House, 992, Shukrawar Peth, Tilak Road, Pune 411002.

Contact: +91 2024491000, 9923977231
Email: secretary@pogs.in