|
Fields marked as * are compulsory. |
|
Register As: |
|
|
Payment Details for Life Members
The Life-membership fee for Indian Nationals : Rs. 4000/-, For Others € 300/- (Euros Two Hundred only) w.e.f. April 1, 2011. Please add Rs. 100/- for outstation cheque.
|
| Name: |
|
|
Date of Birth: |
|
Date |
Month |
Year |
|
|
|
|
|
|
*Office Address: |
500 alpha-numeric characters max. Special characters allowed are . ( ) , -
|
|
*Office Telephone: |
Fax:
Please enter the telephone numbers along with Country Code + City Code e.g. 91-22-2559 0642
|
|
*Email (preferably non-institutional) |
Secondary Email:
|
|
Residential Address: |
500 alpha-numeric characters max. Special characters allowed are . ( ) , -
|
|
Residential Telephone: |
* Mobile:
Please enter the telephone numbers along with Country Code + City Code e.g. 91-22-2559 0642
|
|
*Present Designation: |
30 alphabets max. Special characters allowed are . ( ) , -
|
|
Education: |
|
Electrochemical
Systems Available: |
500 alpha-numeric characters max. Special characters allowed are . ( ) , -
|
|
Details of International Visits In last 5 years:(Professor’s name, laboratory, address and email etc.)
|
200 alpha-numeric characters max. Special characters allowed are . ( ) , -
|
|
*Mode of Payment: |
Click here to know more about Financial Corrospondence (opens in a new window)
|
| |
|
| Publications: |
Attach file (PDF, DOC) with details of your latest Publications in Electro analytical Chemistry
(Please mention max. 10, Details may include Professor’s name, laboratory, address and email etc.)
|
|
*Attach your latest passport-size photo: |
Formats Allowed : JPG, PNG
SIZE must be 75 X 100 pixels
|
*
|
|