Society for Free Radical Research – India
(Affiliated to SFRR- Asia and SFRR-International)
(Registration No. M.S./Mumbai 64/2001)
Application for Membership
Full Name
: ____________________________________________________
(In BLOCK LETTERS)
Date of birth: _________________ Sex: _____ Nationality: ___________________
Institutional address: ______________________________________________________
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Address for correspondence: ________________________________________________
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Phone: (O)_______________ (R)__________________ Fax: _____________________
Email:____________________________________
Academic Qualifications: __________________________________________________
Professional experience:____________________________________________________
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Current Research Interests : _________________________________________________
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Membership Fee (Payable through a bank demand draft in favour of ‘Society for Free Radical
Research-India’)
Indian: Ordinary Member – Rs. 250/- per annum + Entrance Fee - Rs. 50
Student Member - Rs. 150/- per annum + Entrance Fee - Rs. 50
Foreign Student Member - US$ 10/- per annum
Life Member - $ 100/Rs.5000
Associate Life member: Rs. 2500
Corporate Member – Rs. 10000 ($250).
I enclose herewith Rs./US$ ---------------------- by demand draft No. -----------------------Drawn on ----------------------------------------- dated--------------------- as membership fee.
Place : _____________________
Date: ___________________
Signature ______________________
Introduced by __________________________
Please fill up the form and send it along with DD to the following address:
Dr. S. Santosh Kumar
Secretary-General, SFRR-India
C/o Radiation Biology & Health Sciences Division
Bhabha Atomic Research Centre
Mumbai 400 085, India
Email: ssantosh1972@yahoo.com
For office use
Membership No.------------------------ Allotted by ------------------- on ------------------------