VRAG MEETING 2026 - Registration

Vitreo Retina Association, Gujarat Life membership form

Full Name *

WhatsApp Mobile No. *

Residence Address *

Hospital Address *

Clinic Mobile (For Directory) *

Ophthalmology Degree *

Degree College / Institute Name *

Degree City Name*

Degree State Name*

Year of Completion *

Type of Practice *

Retina Fellowship Institute (If applicable)

Fellowship City (If applicable)

Fellowship Year (If applicable)

Medical Registration No. & State *

Current Practice Setup *

Current Hospital/Institute Name *

VRSI Membership No.

AIOS Membership No.

Document Submission

Current Photo (for ID)*

Degree Certificate

Fellowship Certificate

Membership Fee: ₹1000

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