Institutional Membership Form

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Institutional Membership Form

Name of the Institution/Department *

Mailing Address

Membership of academic Societies and Institution

1. Name of Persons who will represent the institution in the Society

1. Designation, Address & Tel./Email

2. Name of Persons who will represent the institution in the Society

2. Designation, Address & Tel./Email

We hereby declare that if elected as an Institution member of the Society, we will abide by the statutes and Regulations of the Society and offer our cooperation in promoting its objectives.

Signature

Status of the signatory

Profile Picture

Required upload size: 0.1MB - 1MB

Please attach a .jpg, .png, .gif or .mpg image. By attaching an image to use as your profile picture you assert that you have rights to use the image and it is not illegal, pornographic or violent in any way.

Payment Slip

Required upload size: 0.1MB - 2MB

Field in which the organization is working

If you are human, leave this field blank.

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Institutional Membership Form

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