Scribd Logo
Upload

Welcome to Scribd!

  • 42 views

    Proposal For Membership of The Association: Email

    Uploaded by

    Anonymous mKIr49
    This document contains a membership application form for the UP Chapter of the Indian Association of Pathologists Microbiologists. The form requests information such as the applicant's name, date of birth, gender, nationality, present designation, addresses, academic qualifications, affiliations/honours, publications, total experience, specialization, type of membership applying for, proposers details, and an undertaking agreeing to abide by association rules. The form notes that applications must be accompanied by documents proving identity, qualifications, age, and proof of IAPM/chapter life membership for proposers.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Proposal For Membership of The Association: Email

    Uploaded by

    Anonymous mKIr49
    42 views2 pages
    This document contains a membership application form for the UP Chapter of the Indian Association of Pathologists Microbiologists. The form requests information such as the applicant's name, date of birth, gender, nationality, present designation, addresses, academic qualifications, affiliations/honours, publications, total experience, specialization, type of membership applying for, proposers details, and an undertaking agreeing to abide by association rules. The form notes that applications must be accompanied by documents proving identity, qualifications, age, and proof of IAPM/chapter life membership for proposers.

    Original Description:

    membership form UP chapter

    Original Title

    Form

    Copyright

    © © All Rights Reserved

    Available Formats

    DOCX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document contains a membership application form for the UP Chapter of the Indian Association of Pathologists Microbiologists. The form requests information such as the applicant's name, date of birth, gender, nationality, present designation, addresses, academic qualifications, affiliations/honours, publications, total experience, specialization, type of membership applying for, proposers details, and an undertaking agreeing to abide by association rules. The form notes that applications must be accompanied by documents proving identity, qualifications, age, and proof of IAPM/chapter life membership for proposers.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    42 views2 pages

    Proposal For Membership of The Association: Email

    Uploaded by

    Anonymous mKIr49
    This document contains a membership application form for the UP Chapter of the Indian Association of Pathologists Microbiologists. The form requests information such as the applicant's name, date of birth, gender, nationality, present designation, addresses, academic qualifications, affiliations/honours, publications, total experience, specialization, type of membership applying for, proposers details, and an undertaking agreeing to abide by association rules. The form notes that applications must be accompanied by documents proving identity, qualifications, age, and proof of IAPM/chapter life membership for proposers.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    You are on page 1of 2

    UP CHAPTER OF INDIAN ASSOCIATION OF PATHOLOGISTS MICROBIOLOGISTS

    PROPOSAL FOR MEMBERSHIP OF THE ASSOCIATION

    1. Name First Name :_______________________________________________________________


    (in full)
    Middle Name :________________________________________________________________

    Surname : ________________________________________________________________

    2. Date of Birth: _______________ 3. Age at Application 4. Gender M/F


    (Attach Proof)
    5. Nationality:
    6. Present Designation and Occupation.

    7. Address (Tick preferred address for communication)


    Official/Clinic/Laboratory Residential

    *Pin Code: *Pin Code:


    Mobile: Mobile:

    *Email:

    8. Academic Qualifications, in descending order (Attach Proof) :

    S.No. Degree Year of University / Board


    Qualification
    01
    02
    03
    04

    9. Affiliations/Honours:

    10. Publications: Books, Chapters in Books, Journals (Attach additional sheet)

    11. TOTAL EXPERIENCE IN SUBJECT__________________________________________________________ years


    12. SPECIAL INTEREST / SPECIALIZATION:______________________________________________________
    13. Membership applied for : Honorary / Associate / Affiliated / Ordinary / Life (Direct) / Life (Existing ordinary Member)
    14. This application is proposed by the following who are Life members of UP IAPM Chapter / IAPM parent body

    S No. Name & Address of the Proposer Membership No. Signature


    01

    Mobile No.
    Email :

    02

    Mobile No.
    Email :
    15. Undertaking: ______________________________________, an applicant to the Associate / Affiliated / Ordinary / Life
    Membership of UP Chapter of Indian Association of Pathologists Microbiologists hereby attest that the information’s provided
    are true to the best of my knowledge and belief. On acceptance of my membership, I shall abide by the rules of the association and
    shall strive to uphold the dignity and objectives of the association. I also agree to pay the membership fees and other dues as
    required from time to time.

    Date:__________ Place:_______________ Signature______________

    * Mandatory fields

    FOR USE BY OFFICE

    Application received: Complete / Incomplete

    Fees Received :

    Membership number allotted :

     All applications should be accompanied with the following (mandatory)


    o Membership form duly filled, signed, proposed and seconded
    o Copy of MBBS and MD/ Diploma degrees
    o Certificate of Additional Qualification/Affiliation / Honors
    o Proof of age
    o Certificate of proof from head of Department in the case of students / Scholar / Residents / Affiliated
    member and Indicate IAPM / UP Chapter life membership number of HOD
    o DD/ Cheque / Details of NEFT

    You might also like