Member Registration

Membership Registration Application

Personal Details

Name *

Father's Name / Husband's Name *

Gender *

DOB *

Age *

Blood group *

Email *

Contact No *

WhatsApp No *

Address Details

Permanent Address

Current Address Same as Permanent Address

At *

Post *

PS *

State *

DIST *

Pincode *

Occupational / Professional Details

Desigantion *

Hospital Type *

Name of the Hospital *

Date of Joining in Service *

Date of Regularization in Service *

Date of Superanuation *

Present Place of Posting *

Name of The Dist (Where Place of Posting is Coming Under) *

Marital Status

Upload Relevant Documents / Information (Change name of the file Special character not allowed in file name)

Nursing Registration Certificate Issued by ONMRC (only PDF)

Regularisation Order / HRMS ID Card (only PDF)*

Aadhar Card (only PDF)*

Photo (only JPG)*

Signature (only JPG)*

Declaration

1. I do hereby declare that the information furnished by me in this format are genuine and if, at any time in future the same will be found forged or manipulated in any manner, that I will be held liable for the consequences as per the decision taken by the Association.
2. I hereby agree to be the bonafide member of the Odisha Nursing Employees Association.
3. I further agree to pay regularly the annual membership fee , maintenance Fee and arrear dues etc. and abide by all the existing rules and regulation which may be prescribed by the Association from time to time.