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INDIAN IMMUNOLOGY SOCIETY

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					                 INDIAN IMMUNOLOGY SOCIETY


                      LIFE / STUDENT* Membership Application Form
                                                                       Sex
Name
                                                                       (M/F):
Date of Birth
Designation
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*/ 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

                                                                                   Signature


                                               Official
Receipt No                                                             Issued on

Issued by

Treasurer, IIS

Please mail the form and the payment along with a copy of your CV to
Dr. D. N. Rao, (Secretary-IIS)
Professor
Department of Biochemistry,
All India Institute of Medical Sciences,
New Delhi-110029, INDIA
Tel. +91-11-2659 3545
Fax: +91-11-2658 8641
E-mail: dnrao311@rediffmail.com

				
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