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    Application Form For Life Membership Andhra Pradesh Chapter of Association of Physicians of India

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    krishna
    This document is an application form for life membership in the Andhra Pradesh Chapter of the Association of Physicians of India. It requests basic personal information such as name, qualifications, address, and contact details. It specifies the membership fees for life membership (Rs. 2,000) and associate membership (Rs. 1,000). The applicant must sign to declare that the information provided is true and to agree to abide by the association's rules if admitted. Required enclosures include a demand draft for fees, a photo for an ID card, and copies of certificates.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Application Form For Life Membership Andhra Pradesh Chapter of Association of Physicians of India

    Uploaded by

    krishna
    95 views1 page
    This document is an application form for life membership in the Andhra Pradesh Chapter of the Association of Physicians of India. It requests basic personal information such as name, qualifications, address, and contact details. It specifies the membership fees for life membership (Rs. 2,000) and associate membership (Rs. 1,000). The applicant must sign to declare that the information provided is true and to agree to abide by the association's rules if admitted. Required enclosures include a demand draft for fees, a photo for an ID card, and copies of certificates.

    Original Description:

    AP State Membership-Form

    Original Title

    AP State Membership-Form

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    This document is an application form for life membership in the Andhra Pradesh Chapter of the Association of Physicians of India. It requests basic personal information such as name, qualifications, address, and contact details. It specifies the membership fees for life membership (Rs. 2,000) and associate membership (Rs. 1,000). The applicant must sign to declare that the information provided is true and to agree to abide by the association's rules if admitted. Required enclosures include a demand draft for fees, a photo for an ID card, and copies of certificates.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    95 views1 page

    Application Form For Life Membership Andhra Pradesh Chapter of Association of Physicians of India

    Uploaded by

    krishna
    This document is an application form for life membership in the Andhra Pradesh Chapter of the Association of Physicians of India. It requests basic personal information such as name, qualifications, address, and contact details. It specifies the membership fees for life membership (Rs. 2,000) and associate membership (Rs. 1,000). The applicant must sign to declare that the information provided is true and to agree to abide by the association's rules if admitted. Required enclosures include a demand draft for fees, a photo for an ID card, and copies of certificates.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    APPLICATION FORM FOR LIFE MEMBERSHIP

    ANDHRA PRADESH CHAPTER OF


    ASSOCIATION OF PHYSICIANS OF INDIA
    To
    The Hony. Secretary, R/No.
    Andhra Pradesh Chapter of
    Association of Physicians of India, Date :
    Department of Medicine,
    Government General Hospital, Membership No :
    KAKINADA- 533001.

    We hereby propose the admission :


    ( PLEASE FILL THE APPLICATION IN BLOCK LETTERS)
    Surname

    Name

    Qualification Year of obtaining first Postgraduate Qualification

    College

    University

    Permanent
    Address

    City / Town Dist.

    Pincode Mobile

    Phone (Resi) Phone (Off)

    E-mail

    API Membership No (National Body)

    As a Life Member Associate Member of the Association (Please appropriate)

    Membership Fees : Life Member - Rs. 2,000/- ; Associate Member - Rs. 1,000/-
    On line remittance : Vijaya Bank, G.G.H. Branch, Kakinada - 1.A/c. No. 480201011003089. IFSC Code : VIJB0004802
    Demand Draft In favour of Hon.Secretary “ The Association of Physicians Andhra Pradesh Chapter ” payable at Kakinada
    (DD # Dt. Bank :

    Signature of the Proposer Signature of the Seconder

    Name : Name :

    Membership No : Membership No :

    Declaration : All the above information provided is true to the best of my knowledge.
    Membership is subject to the approval of the Governing Body in an ordinary or a special meeting.
    I agree to become a member and if admitted, will abide by the Rules and Regulations of the Association.
    Encl : 1) Above said Demand Draft.
    2) One Extra Photo for ID Card
    3) Xerox Copy of MD Certificate & One Photo Copy of Proof of Identity Signature of the Applicant

    Remarks : 1) Qualification : MD / DNB 2) API National Body Membership No.

    For API Office Use - Scrutiny by Name Signature Dt.

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