APPLICATION FORM
ALL INDIA ASSOCIATION FOR ADVANCING RESEARCH IN OBESITY |
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To, The Hon. Secretary Association for Advancing Research in Obesity |
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Dear Sir, I, hereby, apply to be enrolled as Member of the IAARO as Life / Affiliate Life / Associate / Corporate Member / Annual Membership. |
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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 : ________________________ |
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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)
- A) Life Member (Medical Practitioner)
- B) Couple Life Members
- C) Affiliate Life Members (Paramedical Practitioners like nutritionist, dietitian, physiotherapist, therapist etc.)
- D) Couple Associate Member (Automatically terminated after three years)
- E) Corporate Member (Automatically Terminated after three years)
- 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
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