NATIONAL ASSOCIATION FOR APPLICATIONS OF RADIOISOTOPES AND RADIATION IN INDUSTRY
(Regd. No. BOM-76/78 G.B.B.)
Project House, VNP Marg, Mumbai - 4000094
APPLICATION FOR MEMBERSHIP: Click to download Membership Form
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1.0 For Office Use only: 1.1 APPLICATION No.: ___________________________________________ 1.2 DATE RECEIVED: ____________________________________________ 1.3 APPLICATION DISCUSSED IN EXECUTIVE COMMITTEE MEETING NO:____ DATED: ____ 1.4 APPLICATION APPROVED / NOT APPROVED: ______________________ 1.5 TYPE OF MEMBERSHIP: _______________________________________ 1.6 MEMBERSHIP No.: ___________________________________________ 1.7 RECEIPT No. & DATE: ________________________________________ |
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2.0 For Applicant (Individual / Student Membership)
2.1 NAME IN FULL:______________________________________________ (Underline the Surname) 2.2 DATE OF BIRTH: _____________________ 2.3 SEX: _______________ 2.4 OCCUPATION / POSITION HELD: ________________________________ 2.5 ADDRESS OF INSTITUTION: ____________________________________ ___________________________________________________________ ___________________________________________TEL. No.: _______ 2.6 MAILING ADDRESS: ___________________________________________ ___________________________________________________________ ___________________________________________TEL. No.: _______ EMAIL ADDRESS: ____________________________________________ 2.7 ACADEMIC QUALIFICATIONS:___________________________________ 2.8 PROFESSIONAL EXPERIENCE:___________________________________ 2.9 TYPE OF MEMBERSHIP DESIRED: ________________________________
____________________________________________________________________________ I have gone through the constitution of the Association and I agree to abide by the same.
Place: ______________________ Date: ______________________ Signature: ______________
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3.0 For Institutional Membership
3.1 NAME OF THE INSTITUTION / COMPANY ___________________________________________________________
3.2 TELEPHONE NO.: ____________________________________________
3.3 MAILING ADDRESS: ___________________________________________ ___________________________________________________________ ___________________________________________________________ 3.4: NAME OF THE PERSONS SPONSORED a)____________________________ DESIGNATION _________________ ALTERNATE b)____________________________ DESIGNATION _________________ c) ____________________________DESIGNATION_________________
3.5 TYPE OF MEMBERSHIP DESIRED _________________________________
Place: ______________________ Date: ______________________ Signature: ____________
I/We have gone through the constitution of the Association and I agree to abide by the same.
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4.0 MEMBERSHIP FEE _____________________________________________________________________________ TYPE OF MEMBERSHIP ADMISSION FEE
4.1 LIFE MEMBER Rs. 2,000/- 4.2 INSTITUTIONAL MEMBER Rs. 10,000/- _____________________________________________________________________________
This form must accompany appropriate membership fee by cheque/DD in
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