Registration/

'*' fields are mandatory

Any queries regarding Online Registration Technical Assistance, Please contact 0824 – 4252005 (10:00 AM – 6:00 PM Working days)

Please, Make sure you are ready with the soft copies of Photo ,BDS, MDS Certificate and Scanned Copy of Payment before you Register.

Note: Dear Postgraduate Students, Please, select Membership Type as ASSOCIATE LIFE MEMBER to proceed

Basic Details

Name*

Enter Name

Gender*

Male

Female

Select Gender

Blood Group*

Select Blood Group

Membership Type*

LIFE MEMBER

ASSOCIATE LIFE MEMBER

Select Membership type

Contact Number*

Enter number

Date of Birth*

Enter Date of Birth

Email ID*

Password*

Enter Password

Confirm Password*

Enter Confirm Password Passwords doesn't Match

Address*

Enter Address

State*

Select State

Pincode*

Enter Current PIN

Clinic Address with State Name and Pincode

Photo*(only .jpg, .png, .jpeg formats allowed)

Select Photo

Payment Details

Payment Mode *

NEFT

WALLET

ONLINE

Select Payment Mode

View Registration amount

Sl No	Membership Type	Amount	Description
1	LIFE MEMBER	9558.00	Life Membership: Rs. 8,000/- + admission fee of Rs.100/- + Rs. 1,458/- 18% GST
2	ASSOCIATE LIFE MEMBER	9558.00	Associate Life Membership: Rs. 8,000/- + admission fee of Rs. 100/- + Rs. 1,458/- 18% GST
3	PATRONS	29500.00	Rs.25,000/- as one time payment + Rs. 4,500/- 18% GST

Amount*

Enter Amount

Date*

Enter Date

Transaction Number*

Enter Transaction Number

A/C Holder Name*

Enter A/C Holder Name

Bank*

Enter Bank

Branch*

Enter Branch

Upload Scanned Copy * (File Size Max 500KB)

Please Upload Only jpg, png,pdf files are allowed!

Bank Account Details

Bank Name	:	Bank of Baroda
Branch	:	Deralakatte Yenepoya University Branch
A/C Number	:	74460100002110
A/C Name	:	Indian Academy of Oral Medicine and Radiology
Account Type	:	SB
IFSC	:	BARB0VJDEYU (0 read this as ZERO)
MICR	:	575012025

Certificate

College name of MDS completion :*

Enter College name of MDS completion

Guide Name :*

Enter Guide Name

HOD Name :*

Enter HOD Name

BDS Certificate* (File Size Max 500KB)

Select BDS Certificate

MDS Certificate* (File Size Max 500KB)

Select MDS Certificate