Membership Form

ISBMR Life Membership Application Form

The Indian Society for Bone and Mineral Research

Chandigarh, India

Life Membership Application Form

Date: First Name: Middle Name: Last Name: Date of Birth: Degree: Designation: Name of Hospital: Mailing Address: City + Code: State: Phone Nos: Mobile No: Email:

Present University / Institutional / Organizational Affiliations

(Attach separately if needed)

Appointment: Institution: Date: Appointment: Institution: Date: Appointment: Institution: Date:

Publication (List One)

(Attach separately if needed)

Payment Details

Cheque/DD No.: Dated: Amount (Rs.): Amount in Words: Drawn On:

Membership Fee: Rs. 5,000 or USD 250 or GBP 200

Fee includes 18% GST. GSTN No.: 07AAAAI1439C1Z7

Bank Details

A/c Name: Indian Society for Bone and Mineral Research
A/c No: 054701002851
Bank: ICICI, Panchsheel Park Branch, New Delhi
IFSC Code: ICIC0000224

President / CEO - ISBMR
Indian Society for Bone & Mineral Research
#2247, Sector 38C, Chandigarh - 160036
Website: www.isbmr.org
Email: info@isbmr.org ; isbmrindia@gmail.com

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