Laser News, Vol.10, No.1, Jan.1999

INDIAN LASER ASSOCIATION


MEMBERSHIP FORM


Full Name* :

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Address for correspondence :

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PIN CODE______________________

Tel No. ________________________

FAX No. _______________________

E-mail address : _______________________________________

Other Address (Res. / Office) :

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Tel No. ________________________

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Date of Birth :

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Academic qualifications :

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Award / honours received :

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Present position :

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Fields of specialization :

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Type of membership requested : Life (Fee: Rs. 500/-) / Institutional (Fee. Rs. 5000/-)

Any particular field in which you would like to contribute : writing articles / giving popular talks / local organization of ILA activities / other (specify)

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Membership payment : Cheque# / Bank Draft No.

Date :

Signature


* Send completed application form along with payment to : General Secretary II, ILA, Laser R & D Block D, Centre for Advanced Technology, CAT INDORE 452 013.


# Make Bank Draft payable to Indian Laser Association payable at Indore. # For outstation cheque add Rs. 30/- for bank charges.


FOR ILA OFFICE

Membership type and No. :

Membership Receipt No. :

Any other remarks :

(General Secretary II)