Membership Form

Application for Membership


To

The Secretary
Indian Virological Society
F-1, National Societies Block
NASC Complex, Pusa
DPS Marg, New Delhi-110 012
India

From (Print your details)

I wish to enroll as annual / life / patron member of the Indian Virological Society. I will abide by the rules and regulations of the Society as in force from time to time. I enclosed prescribed membership fee payable to Indian Virological Society at New Delhi as detailed below:
Currency(Rs/US$):    
Amount (in figures ):

Amount (in Words):   
Payment type:           
 
                   
          
                

Signature:

Date:

Note: Members contact information and research interests will be placed in the IVS database. Tick in the box if you do not like your details to be in database


For the use of Indian Virological Society Office Only

Proposed by:
Name Signature Date
Seconded by:
Name Signature Date
Individual Membership Fee:
Regular Member Student member Regular Member Student member
Annual Membership Rs. 2500 Rs. 1000 US $ 100 US $ 50
Life membership Rs. 6500 - US $ 200 -
Note:1. Payment in cash or by demand draft drawn in favor of Indian Virological Society at New Delhi
2. A admission fee of Rs. 100.00 should be added for a new member.
New Delhi, dated
Membership No.
Received Rs./US$ (in figures and words) :
Treasurer
Secretary