MEMBERSHIP CARD - INDIVIDUAL

• Access to educational health material and awarness meetings
• Annual medical screening for hepatitis B & C and Osteoporosis
• Annual medical screening for Diabetes, Hypertension & Kidney disease for family members
• Medicines at subsidized rate
• Free Hepatitis B vaccines (4 doses)
• Free Subscription to a newsletter- KIDNEY CARE

Life Membership: Rs. 5000/-

Annual Membership: Rs. 1500/-
 

Name:
Date of Birth:
Martial Status:
Address:
Email Id:
Tel No.
Cell No.
Occupation:
Company:
I am suffering from following:	Not Any Diabetes Hypertension Kidney Failure Others
I am enclosing cash/cheque/draft of Rs.:
Drawn on:
Joining Date:
Life Membership:	Rs.5,000.00/-
Annual Membership:	Rs.2,000.00/-

Download Forms for Printing:
 
Individual Form