Name *
Date Of Birth
Gender *
Qualifications *
DegreeYear of PassingInstitute/University
MBBS
MD/MS/DNB
DM/DipNB/MCh/DNB
Others(Specify)
Address Work *
Job Title
Institution/Hospital
Address
City
Pincode
Address Home *
Address *
City *
Pincode *
Mobile Number *
Email *
Academic appointment
Full Time     Part Time     None
Primary Institutional Affiliation
Medical College/Institute
Private multispecialty Hospital
Armed Force
Solo/group practice
Professional interests (tick as many application)*
 
Adult Nephrology
Pediatric Nephrology
Pathology
Pharmacology
Urology
Hemodialysis
Transplantation
Cell/Molecular biology
Radiology
Peritoneal Dialysis
Kidney
Liver
Heart
Basic Sciences
Technical Staff
Other
Qualification Certificate *

A.) MD/MS/DNB/PhD broad speciality or equivalent qualification certificate along with
B.) DM/MCh/DNB super speciality or equivalent qualification or transplant experience certificate


Referees *
Proposed bySeconded by
Full Name
ISOT Membership no.
Email
Mobile Number
Payment Type
Online
Secretariat Office
Dr. Manish R Balwani Honorable Secretary, ISOT.
Saraswati Kidney Care Center 13, New Sneh Nagar, Near Jaiprakash Nagar Metro Station, Jaitala Road, Nagpur – 440015 (MS) Email id: drmanishbalwani@gmail.com, isotsecretary@gmail.com Office Cell No: +91-9021637248