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Indian Society for Radiation Physics

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					                       Indian Society for Radiation Physics
                                    (Regn. No: BOM/83/1992/GBBSD, F-15216)

                                   Application for Membership

Name                                                                          Age
Designation                                                                   Sex
Academic
Qualification
Professional
Experience
Nature of work

Membership in other
Scientific Societies

 Address for Correspondence

                  Official                                       Residence
     Bldg. No                                    House No
   Laboratory                                       Street
    Institution                                    Village
       Village                                     District
           City                                       City
          State                                      State
      Pincode                                     Pincode
        Phone                                       Phone
           Fax                                         Fax
         eMail                                      eMail

I am enclosing herewith a cheque/DD/Cash of rupees
towards Annual membership/ Life membership/Institutional membership/Library membership.


Place :
Date :                                                           Signature:


NB: Cheques and DDs should be drawn in favour of Indian Society for Radiation Physics
    (Kalpakkam Chapter) and should be payable at par in Kalpakkam. The completed forms
    with subscription must be sent to Dr. D. Ponraju, The Secretary, ISRP (K),
    Radiological Safety Division, IGCAR, Kalpakkam – 603 102.

                             Admission Fee        Rs. 50/-
                             Life Member          Rs. 500/-
For Office Use:
Date of receipt of application:
Application received by:
Admitted on:
Membership status:
Receipt No:
Life Membership No:
LM fees sent to main on
LM certificate issued on
Membership transfer - reg.
                                                       Membership number
                                                       Membership status

Annual members subscription information:
Year    Paid (Y/N)     Year       Paid (Y/N)   Year   Paid (Y/N)

				
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