Membership Form - Click here

 

Indian Society for Malaria and Other

Communicable Diseases

22-Sham Nath Marg, Delhl-11 0054

MEMBERSHIP FORM

The Secretary,

Indian Society for Malaria and Other Communicable Disease,

22-Sham Nath Marg, Delhi-11 0054

e-mail: ismocd_jcd@yahoo.co.in

Dear Sir,

 

Please enrol me as Life Member of the Indian Society for Malaria and Other Communicable Disease. I hereby agree to abide the rules and regulations of the society.

      I remit Rs........... by Cheque I Bank Draft I Cash as my life membership fee.

 

Yours truly,

 

Signature

Place …….. …                                                  Date ......... …..

Name in the Block Letters.................................................. .............

Profession................................................................................. .......

Designation ................................................................. ....................

Address with Phone, Fax, E-mail ...............................................................         

 

 

 

Address to which Journal should be sent..................................................

 

Permanent Address with Phone, Fax, E-mail ................................................

 

 

The undersigned members of the Indian Society for Malaria and Other Communicable Diseases, support this application for admission to membership of the said Society as the applicant has shown scientific/practical interest in Malaria and Other Communicable Diseases and their prevention.

 

1. …………    ………………… …………………

 

2. ………. ….. ………………..  ……………..

 

 

 

RATES FOR MEMBERSHIP I SUBSCRIPTION * FEES

 

 

1. Life Member (India )                        Rs.2500/-

 

2. Life Member (Abroad)

 

Supported through grant             $500/­

 

Self                                              $250/-

 

3.SAARC country                                  $100

 

4. Subscription for the journal

 

Annual (India)      Rs.1000/-

 

Single copy          Rs.250/-

 

Annual (Abroad)  $60/-

 

Single copy          $15/-

 

Air surcharge $8/- (extra) in case delivery of the journal is desired by Air Mail.

 

 

NOTE

 

(a)   Cheque, Bank Draft, sent toward subscription/membership fees should be

     payable to the “Indian Society for Malaria and Other Communicable

     Diseases”

 

 (b) In case of outstation Cheque please add Rs.50/- as Bank commission

 

 

·        Request for subscription for J Commun Dis by Institutions/Libraries, Colleges etc can be made on plain paper alongwith the required amount of subscription.

   

 

Indian Society for Malaria and Other Communicable Diseases

22-Sham Nath Marg, Delhi-11 0054

 

 

BIODATA FORM TO BE FILLED IN BY LIFE MEMBERS

 

1.       Name in full: ….. ….. …. …

(Block letters)

 

2.       Place and Date of birth ….  ….  ……

 

3.       Designation/Occupation … …. ……

 

4.       Address

….  …… ……

…. ….. …… ..

…. … … ….

 

 

5.       Nationality:.. …

 

6.       Academic qualifications: … …

 

Degree/Certificate              University/Institute             Year

….. ….

…. …..

…. …..

… …..

 

 

7.       Position held (Start with the recent post)

 

 


 

 

8.       Experience

 

(a) Research:

 

 

 

 

(b) Training

 

 

 

 

(c) Control

 

 

 

 

9.       Recognition/Achievements/Fellowships/Memberships:

 

 

 

 

10.     Publication: (List out beginning with the most recent one)

                             List all authors, titles and where published

 

 

 

 

 

11.     Three best scientific papers (Please send three reprints each)

 

 

 

 

I certify that the above information is correct

 

 

 

Signature of Applicant

Place:

 

Date:

 

 


ISMOCD Directory Proforma

 

To be filled by members of “Indian Society for Malaria and Other Communicable Diseases”.  The following information are required for publication / updating of ISMOCD Directory.

.

1.  

Full name (surname first, in capital letters):

2.  

Present position/designation held:

3.  

Date of birth:_____________day of__________month_____________

4.  

Educational qualification:

5.  

Date of enrolment in ISMOCD:_________day of/_________ month/________.

6.  

Life membership No./receipt no.____________

7.  

Whether life membership certified issued: Yes/ No

8.  

Whether Fellowship of the Society awarded: Yes/ No

9.  

(If yes, please mention year of fellowship)___________

10.             

Membership to other professional bodies (If yes, please mention details)

 

(a)

 

(b)

 

(c)

 

(d)

11.             

Award(s) received (National / International)

 

(i)

 

(ii)

 

(iii)

12.             

Present address

(Including PIN code & Telephone No. e-mail. Use capital letters}

 

 

 

 

 

 

13.             

Permanent  address

(Including PIN code & Telephone No. e-mail. Use capital letters)

 

 

 

 

 

If you know any member of the Society, whose name is not in our mailing list, please inform the details. This proforma can be photocopied