Name of the Applicant............................................................................................................................................................................
Present Status & Designation................................................................................................................................................................. Communication Address........................................................................................................................................................................
Registration No. :.................................................................................................................................................................................... Registering Authority :.......................................................................................................................................................................... Name & Address of Proposer :............................................................................................................................................................ Membership No. of Porposer :........................................................................................................................................................... Signature of Proposer :.......................................................................................................................................................................... Name & Address of Seconder :............................................................................................................................................................ Membership No. of Seconder :............................................................................................................................................................. Signature of Seconder :..........................................................................................................................................................................
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(Signature of the applicant) SUBSCRIPTION RATE
Life/Associate Membership Fee Rs.6500/- Student Membership Fee Rs. 3000/- Annual Subscription Rs. 1000/- (This fee is inclusive of Admission Fee of Rs. 500/-). The amount to be remitted by a cross Demand Draft Draw in favour of "Indian Academy of Pediatrics" payable at Mumbai.
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The Membership Fee should be paid by a crossed bank draft
drawn in favour of “INDIAN ACADEMY OF PEDIATRICS” payable at Mumbai. |