INDIAN IMMUNOLOGY SOCIETY

                                          

LIFE MEMBERSHIP APPLICATION FORM

Name                     :

 

Sex (M/F):

 

Date of Birth         :

 

Designation          :

 

Address (Office)  :

Address (Home)  :

 

Corresponding Address                     :

Phone                     :

 

Mobile:

 

Fax:

 

Email                     :

 

Field of Work       :

 

 (Please attach a brief CV)

 

I would like to join the Indian Immunology Society as a Life Member. I am enclosing a Bank Demand Draft No./Online Txn. No. ______________________________ Dated________________  Bank______________________, in favour of "Indian Immunology Society" payable at New Delhi for the sum of Rs.4,000/-  (Life Member). Please enroll me as a Life Member of the Society.

 

Bank details for Online Transfer

Name: Indian Immunology Society

Account No.: 10874587599 

Bank: State Bank of India

IFSC Code: SBIN0001536

 

 

Note: Membership Fee US $ 100.00 for all overseas applicants.

 

Signature

For Official Use

Receipt No.

 

Issued on

 

Membership No.

 

 



                                                                                Issued by:

 

 

Treasurer, IIS

 

Please mail the filled Form and D.D./ Online Txn. Receipt along with a copy of your CV to:


Dr. Alpana Sharma

Treasurer, Indian Immunology Society

Professor, Department of Biochemistry
All India Institute of Medical Sciences
New Delhi-110029, INDIA
Tel.: +91-11-26546665
E-mail: treasureriis2014@gmail.com