THE KANDY SOCIETY OF MEDICINE

Dear Life member,

It has become necessary to update the KSM membership information in order to regularize the communications,
between the office & the members so that the membership could be made aware of the events taking place
through the KSM.
Please be kind enough to fill the following information & send it to the KSM office before 15 th June 2010. If there
is no response by the said date, it will be regarded as if you are not willing to get the KSM information in the
future.
Please be updated with activities of KSM by using our website ‘www.theksm.org’
Thank you
Yours faithfully

…………………………….
Dr. Anurangani Vithana
Joint Secretary – KSM

 Name (with initials): - ……………………………………………………………………………

 Names denoted by initials: - ………………………………………………………………………

 Present post: - ……………………………………………………………………………………..

 Address:-
1. Home – ……………………………………………………………………………………

……………………………………………………………………………………………

2. Office – ………………………………………………………………………...................

……………………………………………………………………………………………

 Telephone – Home Office Mobile

 E-mail – ……………………………………………………………………

 State whether you expect to receive KSM information

by e-mail in future – Yes No

 If ‘Yes’ indicate the events you Social events

wish to be informed – Educational events
- CME lectures
- Guest lectures / Symposia
- Annual sessions

Signature: - ……………………………….. Date - …………………………….

KSM OFFICE, GENERAL HOSPITAL (TEACHING), KANDY

Tel: 081-2201702 Fax: 081- 2233336
Email: theksm66@gmail.com Website: www.theksm.org