Application for Membership

( contact & Occupational Dermatoses Forum of India )

I Wish to become a member of contact & Occupational Dermatoses Forum of India and I agree to abide by the rules and regulations of the Contact & Occupational Dermatosis Forum of India (CODFI) as laid down in current memorandum of the Forum of the Forum and as may be applicable in the future. I will endeavor to further the cause of Contact Dermatitis in India to the best of ability.

Full Name *

Age in years *

Full Address *

City *

State *

Email Address *

Mobile No. *

Designation *

Clinic/Institute *

Office Address *

IADVL Membership Number and State *

Qualifications:- *

MD ( Dermatology)

DNB

Diploma

any other

Remittance Details:- for digital payment you can pay through any mode digital payment directly to bank (details given below) for scanning QR Code just go down and pay.

Bank Name:- J & K BANK, GMC Srinagar

Account Name:- CODFI

Account Type:- Current Account

Account Number:- 0349010100000964

IFSC Code;- JAKA0DOCTOR

Fee For becoming CODFI Member Rs. 2360/-

Kindly send the screenshot of transaction details, passport Size Photograph with your name and self attested photocopy of Postgraduate Degree codfiho@gmail.com

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Membership Form

Application for Membership

( contact & Occupational Dermatoses Forum of India )