Association-Of-Hair-Restoration-Surgeons-India
Membership Application
Association of Hair Restoration Surgeons India
 
  Aims and Objectives PDF Form Download
 
  To complete this application PDF Form Download
 
  Send completed application, required supporting materials, and application fee to:  
 
Dr. Anil Garg, Honorary Secretary
Association of Hair Restoration Surgeons
2/1 RS Bhandari Marg,
Jangirwala Chouraha,
Indore 452003, India.
Application Fee, subject to change (Invoiced after acceptance. Processing fee of Rs 500/- will be deducted if fee is refunded)
All the payment in form of Bank Draft only should be forwarded favouring-

“ASSOCIATION OF HAIR RESTORATION SURGEONS INDIA” (payable at Mumbai)
The draft in favor of Association, should accompany the application form and sent to the Hony. Secretary and no other direct payments
Indicate: Bank Draft Number:      Bank Branch:       Amount:

  AFFIRMATIONS  
 

I, hereby apply for membership in the Association of Hair Restoration Surgeons. (Hereafter referred to as AHRS)

In consideration of AHRS processing my application for membership, I hereby grant permission for the AHRS to obtain information regarding hospital staff privileges and actions relating thereto, information from former medical society affiliations, specialty organizations, the Medical Council of India, appropriate State medical councils, medical colleges/ institutes and other organizations providing medical training including internship and residencies.

I further authorize disclosure of information generally considered to be reliable which has a bearing on my professional competence, character and ethical qualifications to all hospitals and medical licensing and discipline boards who request such information.

I hereby release and hold harmless from any liability or loss, the AHRS, its officers, agents, employees and members for acts performed in good faith and without malice in connection with evaluating my application and my credentials and qualifications, and hereby release from any liability any and all individuals and organizations, who, in good faith and without malice, provide information to the AHRS, to its authorized representatives, concerning my professional competence, ethical conduct, character and other qualifications for membership.

I further release from liability the AHRS, its officers, agents, employees and members for delivery of information to any third party as authorized herein provided such delivery occurs prior to the acknowledged receipt, in the office of the AHRS, or a written notice of revocation of this release.

I have read and understand the Bylaws and Code of Ethics. I hereby agree to abide by the Bylaws and Code of Ethics of the ISHRS and agree upon acceptance, that my membership in the ISHRS shall be conditional upon continued compliance of the aforementioned Bylaws and Code of Ethics.

I HEREBY AFFIRM AND REPRESENT THAT ALL STATEMENTS, ANSWERS AND INFORMATION CONTAINED IN THIS APPLICATION ARE TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF

  CHECKLIST PDF Form Download