NCSC Membership Form

 

NATIONAL CENTRE FOR SCIENCE COMMUNICATORS

VIDNYAN BHAVAN,V.N.PURAV MARG, SION-CHUNABHATTI, MUMBAI 400022.
PHONE 91-22-5224714, 91-22-5226268, FAX 91-22-5226268 E-Mail mavipa@vsnl.com

(Please use Capital letters)

  I/We wish to be a Life Member (Yes / No)
  Name in full (Individual / Institution)
  Address
  Phone nos.
  Fax nos.
  e-mail
  Web site
  Education / Profession (Individual)
  Work Area (Institution)
  Institution

Affix Photograph (Coloured, Passport size) and enclose detailed Bio-Data for Individuals / Information brochure together with latest annual report for Institutions.

Please send the cheque (facility only for Mumbaiites) / Demand Draft (for Outstation people) in favour of `National Centre for Science Communicators' for Rs.2000/- for individual and Rs.10,000 for institution member

Date ____________________________         




Signature ____________________________



Rubber Stamp in case of Institution

 

 

 
N.B. -- Please do not send in your registration fees unless we inform you.