INDIAN IMMUNOLOGY SOCIETY
LIFE / STUDENT* Membership Application Form
Date of Birth
Phone Mobile: Fax
Field of Work
(Please attach a brief CV)
I would like to join the Indian Immunology Society as a Life Member*/ Student Member*. I am
enclosing a bank Draft No___________________, in favour of "Indian Immunology Society"
payable at New Delhi, drawn at________________ for the sum of Rs.1500 (Life Member)/
Rs.500 (Student Member). Please enroll me as a member of the Society.
Note: Membership Fee US $ 100 for all overseas applicants.
Student’s application must be countersigned by the HOD/ PhD supervisor
* Please strike-off what is not applicable
Receipt No Issued on
Please mail the form and the payment along with a copy of your CV to
Dr. D. N. Rao, (Secretary-IIS)
Department of Biochemistry,
All India Institute of Medical Sciences,
New Delhi-110029, INDIA
Tel. +91-11-2659 3545
Fax: +91-11-2658 8641