13 th Annual General body meeting on 23-2-2024 at Hyderabad.

Registration

Enrollment Form

Prefix
First Name
Middle Name
Last Name
Type Of Membership
Gender
DOB (MM/dd/yyyy)
Age  
Qualification
IADVL Member LM NO
State Branch of IADVL  
Address
City
State
Pin Code
Tel No. - STD Code
Tel No. - Residence
Tel No.- Clinic
Mobile
Email
Details of Payment
1. Admission Fees ( as per age) Rs.
2. Annual Membership Fees(Increment of Rs. 50/- every year) Rs.
3. Advance Fraternity Contribution(AFC) Rs.
4. Legal Fees (optional/as per type of practice)
Rs.
5. Advance Payment (optional) Rs.
Total Fees Rs.3250.00
Full Name of the Nominee
If nominee is minor, DOB (MM/DD/YYYY)
Name of Nominee/Guardian with name in case of minor
Relationship with applicant
Address of Nominee
Proposed By. Dr.
Proposed By. Dr. LM No/ DVL Welfatetrust No
Signature Of Nominee   [JPG,JPEG,PNG Only]
Signature (applicant)   [JPG,JPEG,PNG Only]
Note: Payment Link will be sent by office to the registered email.
Hereby declare that the above information is true and I have withheld no information whatever in the Application, and I agree to pay the amount demanded.
 
Further agree to abide by the conditions laid down in the constitution approved by the General Body for this Trust.
 
Submit