Application Form

(Online)
Dear Sir,
Kindly enroll me as Life member of the Indian Pharmacological Society.
I agree to abide by the rules of society.
Life membership fee 3000/- / $350 (include admission fees)
Ordinary member ship fee 800/- / $40(no online facilty available, submit print out of this form for ordinary member ship)


First Name:*
Middle Name: Last Name:
Name to Appear*
Qualifications:*
Photo:
photo
Designation
Official Address:*
Phone: Mobile:*
Fax: Email:*  
Home Address
Bank Details:* Professional Email:  
Proposers profile
Name
NO: Signature:
NO: Signature:
I have gone through the constitution and bye laws of the society and will abide by the same
1. Please send a demand draft in favour of Treasurer, "Indian Pharmacological Society" payable at Ahmedabad
Please send the following along with the application
   Membership form signed by you and proposer
   Demand draft in favor "Indian Pharmacological Society" payable at Ahmedabad
   Academic Certificate
   Reference number received by you
Dr.B.Kalakumar Ph.D., Finance Secretary
Associate Professor,
Department of Pharmacology & Toxicology,
College Of Veterinary Science,
Korutla,
Karimnagar (Dist)
Mobile: 0944 124 2213
Email: bkalakumar@rediffmail.com, ips.membership@gmail.com