PRELIMINARY MEMBERSHIP APPLICATION FORM

(Mumbai Chapter)

I wish to apply for Life membership of Multiple Sclerosis Society of India in the category Life Membership – MS Patient – Rs.200/-.

Payments can be made via NEFT to:  A/C Name – Multiple Sclerosis Society of India, Bank Name – Indian Overseas Bank, Branch – Sion (E), A/C No – 054201000018949, IFSC Code – IOBA0000542