Address for Correspondence:
Dr. Sanjay Sood Hony. SecretaryC-301, Saransh Apartment, Plot No. 34, I.P. Extension, Patparganj, Delhi-110092
Dear Sir,
I hereby apply to you for a life membership of the society.
The amount of As. 4,000/- payable for Life Membership (including Journal Subscription) is remitted herewith :
Number
Dated
Bank Signature of the Applicant
Date:
Mob.: 9810219343 • E-mail: sanjaysood_doc@live.com or allindiarhinologysociety@gmail.com
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MEMBERSHIP FORM
Dear Sir,
I hereby apply to you for a life membership of the society.
The amount of As. 4,000/- payable for Life Membership (including Journal Subscription) is remitted herewith :
Name of the applicant :
Qualification
Attachment
Present Position
Residential Address
Office Address
Phones Office Residence
E-mail Fax
Proposed by Name
LM No. Signature
Seconded by Name
LM No. Signature
Mode of Payment: Cash/Cheque/DD: Favouring - All India Rhinology society (payable at Delhi)
Dated
Bank Signature of the Applicant
Date:

