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Registration-Legal Form

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Full Name*
MCI No*
REG State*
Designation
Department
Institution*
Address
City
Zip/PinCode*
State
Country
Phone(Res)
(Clinic)
Fax
Email*
Mobile*

Bank Details
REGDate
TXNDate*
Bank Name*
UTR No*
Rupees*

Account Details are as Follows

Legal Fee : Rs.20,000/-
Name Of Beneficiary : Indian Society of Clinical Sonologist
Account Type : Savings Bank Account
Name Of Bank : Karnataka Bank Ltd.,
Branch : Cathedral Road Branch, Chennai - 600 086
Account Number : 464 2500 10 20857 01
IFSC Code : KARB0000464
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