Membership Form - Click here
|
|
Indian Society for Malaria and Other
Communicable Diseases
22-Sham Nath Marg, Delhl-11
0054
MEMBERSHIP FORM
1. Name :
2. Fathers Name :
3. Date of Birth :
4. Nationality :
5. Qualification :
6. Designation:
7. Permanent Address with Phone, Fax, E-mail :
8. Area of Expertise :
9. Mode of Payment for Rs. 2500/- (Membership Fee) : Cash / Cheque (Payable to the Indian Society for Malaria and Other Communicable Diseases, 22 Sham Nath Marg, Delhi 110054)
Cheque No.___________________________Name of Bank:___________________________
Date :
Please enroll me as Life Member of Indian Society of Malaria and Other Communicable Diseases. I hereby agree to abide the rules and regulations of the society.
(Signature of the Applicant)
RATES FOR MEMBERSHIP I SUBSCRIPTION * FEES
1. Life
Member (
2. Life
Member (Abroad)
Supported
through grant $500/
Self $250/-
3.SAARC country $100
4. Subscription for the journal
Annual (
Single copy Rs.250/-
Annual
(Abroad) $60/-
Single copy $15/-
Air surcharge $8/- (extra) in case delivery of the journal is desired by Air Mail.
NOTE
(a)
Cheque,
Bank Draft, sent toward subscription/membership fees should be
payable to the Indian Society for Malaria and Other Communicable
Diseases
(b) In case of outstation Cheque please add
Rs.50/- as Bank commission
·
Request
for subscription for J Commun Dis by Institutions/Libraries, Colleges etc can
be made on plain paper alongwith the required amount of subscription.
Indian Society for Malaria and Other Communicable
Diseases
22-Sham Nath Marg, Delhi-11 0054
BIODATA FORM TO BE FILLED IN BY LIFE MEMBERS
1. Name
in full:
..
..
.
(Block
letters)
2. Place
and Date of birth
.
.
3. Designation/Occupation
.
4. Address
.
.
..
..
.
.
5. Nationality:..
6. Academic
qualifications:
Degree/Certificate University/Institute Year
..
.
.
..
.
..
..
7. Position
held (Start with the recent post)
8. Experience
(a) Research:
(b) Training
(c) Control
9. Recognition/Achievements/Fellowships/Memberships:
10. Publication:
(List out beginning with the most recent one)
List all authors,
titles and where published
11. Three
best scientific papers (Please send three reprints each)
I certify
that the above information is correct
Signature
of Applicant
Place:
Date:
ISMOCD Directory Proforma
To be filled by members of Indian Society for Malaria and Other Communicable Diseases. The following information are required for publication / updating of ISMOCD Directory.
.
|
1. |
Full name (surname first, in capital letters): |
|
2. |
Present
position/designation held: |
|
3. |
Date of
birth:_____________day of__________month_____________ |
|
4. |
Educational
qualification: |
|
5. |
Date of
enrolment in ISMOCD:_________day of/_________ month/________. |
|
6. |
Life
membership No./receipt no.____________ |
|
7. |
Whether life
membership certified issued: Yes/ No |
|
8. |
Whether
Fellowship of the Society awarded: Yes/ No |
|
9. |
(If yes,
please mention year of fellowship)___________ |
|
10.
|
Membership
to other professional bodies (If yes,
please mention details) |
|
|
(a) |
|
|
(b) |
|
|
(c) |
|
|
(d) |
|
11.
|
Award(s)
received (National / International) |
|
|
(i) |
|
|
(ii) |
|
|
(iii) |
|
12.
|
Present
address (Including PIN code & Telephone
No. e-mail. Use capital letters} |
|
|
|
|
13.
|
Permanent address (Including PIN code & Telephone
No. e-mail. Use capital letters) |
|
|
|
If you know any member of
the Society, whose name is not in our mailing list, please inform the details.
This proforma can be photocopied