THE INDIAN SOCIETY OF HUMAN GENETICS

Application for Membership

1. Full Name : ________________________________________________________________

2. Date of Birth : _________________________________________ 3. Sex :_______________

4. Mailing Address : __________________________________________________________

Tel. No. _______________ Fax No. _______________ Email ___________________________

5. Education : 

Degree Year   University


6. Present position : _________________________________________________________

7. Area of interest in Human Genetics : ____________________________________________

8. No. of publications: ___________________
(List of publications, if any, must be sent along with this application)

(Signature of Applicant) withdate

9. Sponsors

Name Address Signature and date
1.
2.

_________________________________________________________________________________________

FOR OFFICE USE ONLY

Application
received on		 Considered
by GC on		 Decision
of the GC		 Signature
of the Secretary		 First
payment

MEM Reg. No.

_________________________________________________________________________________________

INSTRUCTION TO THE APPLICANT

1. Admission fees Rs. 10/-
Life Membership fees Rs. 800/-
Ordinary membership fees Rs. 80 per year
Associate membership fees Rs. 40 per year

PLEASE DO NOT SEND ANY PAYMENTS ALONG WITH YOUR APPLICATION

Cheque/Draft should be drawn in favour of 
THE INDIAN SOCIETY OF HUMAN GENETICS, payable at Kolkata
3. Please return the application form to: Prof. B. M. Reddy, Secretary, ISHG
Anthropology and human Genetics Unit
Indian Statistical Institute, 203, B.T. Road
Kolkata 700108, India