APPLICATION FORM

ALL INDIA ASSOCIATION FOR ADVANCING RESEARCH IN OBESITY
To,
The Hon. Secretary
Association for Advancing Research in Obesity
Dear Sir,
I, hereby, apply to be enrolled as Member of the IAARO as Life / Affiliate Life / Associate / Corporate Member / Annual Membership.
Last Name : _____________________________                   First Name: ______________________________
Father's/Husband's Name : ________________________________________________________________________________
Address: ______________________________________________________________________________________________
Ph. : (O) _________________________      (R) _____________________________      (M) ____________________________
E-Mail : _________________________________                    DOB: ______________________________
Qualification: __________________________________________________________________________________________
College: ______________________________________________________________________________________________
University: ____________________________________________________________________________________________
If at any time this statement is found to be incorrect, my membership, if granted will be liable to be cancelled and the fee paid by me to AARO will be liable to be forfeited by them.
Please accept the sum of Rs.___________________________________________ As my/our membership fees.
Date: _________________      Place: _________________________      Signature : ________________________

Membership Subscription
1. Life Member :   Rs. 3000/-
2. Couple :   Rs. 5000/-
3. Affiliate Life Member :   Rs. 3000/-
4. Associate Member :   Rs. 1000/-
5. Couple Associate Member :   Rs. 1500/-
6. Corporate Member :   Rs. 25000/-
7. Obesity Interest Group      
  Annual Subscription :   Rs. 300/-

LIFE MEMBER
(Medical Practitioners Life)
  1. A)     Life Member (Medical Practitioner)
  2. B)     Couple Life Members
  3. C)     Affiliate Life Members (Paramedical Practitioners like nutritionist, dietitian, physiotherapist, therapist etc.)
  4. D)     Couple Associate Member (Automatically terminated after three years)
  5. E)     Corporate Member (Automatically Terminated after three years)
  6. F)     Honorary Member

Address

Dr Banshi Saboo, Dia care,
1 & 2, Gandhi Park,
Nehru Nagar Circle # Road,
Ambe wadi, Ahmedabad- 380015.
Gujarat, India.
Ph. : +91-79-26304 104 / 8104
Fax: +91-79-26302 104
E.Mail : banshisaboo@hotmail.com

Click on download for Application Membership Form



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