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MEMBERSHIP FORM- ENVIRONMENT & CHILD HEALTH CHAPTER OF INDIAN ACADEMY OF PAEDIATRICS.

Name

IAP Membership No./ Home Branch

Age in completed years

Date of Birth

Qualification

Designation

Address

Pincode

Email Address (Just for Contact Purpose)

Contact No

Area of interest in Environmental & Child Health

Membership- Rs. 1,000/- per candidate

Payment by Cheque/DD/NEFT/IMPS

BANK: Federal Bank

NAME : Environment & Child Health Group of IAP Sub Speciality Chapter

A/C NUMBER: 10710100348103

AE TYPE : Saving Bank (SB)

IFSC CODE S: FDRL0001071

BANK BRANCH: Vadakara

Payment Ref. No. / Payment date

Consent- I will abide by rules & regulation of ECHG chapter of IAP as a responsible member of the organisation.

Membership

MEMBERSHIP FORM- ENVIRONMENT & CHILD HEALTH CHAPTER OF INDIAN ACADEMY OF PAEDIATRICS.

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