Membership To Society
L-3/1 Kuchnar City, Lamti Madhotal Vijay Nager Jabalpur -482002(M.P)
Society for Research, Diagnosis and Treatment of Human Fungal Diseases (SRDTHFD)
To,
Secretary,
Society for Research, Diagnosis and Treatment of Human Fungal Diseases. (SRDTHFD).
Dear Sir,
I desire to become on Annual Member/Life Member/Student Member (select correct option) of SRDTHFD. I have remitted the membership fee, inclusive of admission fee, through DD No_____________ dated____________ drawn in favor of the Secretary, SRDTHFD (payable at Jabalpur M.P. India).
Place:
Date :
Yours cordially ,
Name ( in Block Letter) _____________________________________________
Date of birth _____________________________________________
Degrees (with year) ______________________________________________
Specialization ,if any ______________________________________________
Present Position ______________________________________________
Address ______________________________________________
______________________________________________
______________________________________________
Mob/Telephone ______________________________________________
E mail ID ______________________________________________
Secretary,
Society for Research, Diagnosis and Treatment of Human Fungal Diseases. (SRDTHFD).
Dear Sir,
I desire to become on Annual Member/Life Member/Student Member (select correct option) of SRDTHFD. I have remitted the membership fee, inclusive of admission fee, through DD No_____________ dated____________ drawn in favor of the Secretary, SRDTHFD (payable at Jabalpur M.P. India).
Place:
Date :
Yours cordially ,
Name ( in Block Letter) _____________________________________________
Date of birth _____________________________________________
Degrees (with year) ______________________________________________
Specialization ,if any ______________________________________________
Present Position ______________________________________________
Address ______________________________________________
______________________________________________
______________________________________________
Mob/Telephone ______________________________________________
E mail ID ______________________________________________
Membership Charges
Annual Membership : Rs. 300
Life Membership fee : Rs. 1500
Student Membership fee (Annual) : Rs. 200
Please send the above mentioned form, duly filled in your own hand writing, along with demand draft of respective fee to :-
Dr. Shesh Rao Nawange, (Secretary SRDTHFD)
Fungal Disease Diagnostic and Research center, L-3/1 Kuchnar City, Lamti Madhotal Vijay Nagar Jabalpur (M.P.) Indea 482002
Contact No.:- 7000973672
Contact No.:- 7000973672
Contact Email:-sr.nawange@gmail.com, srnawange@rediffmail.com
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