Membership Form

 MUSHROOM SOCIETY OF INDIA Headquarters: Directorate of Mushroom Research CHAMBAGHAT, SOLAN (H.P.) – 173213. Tel.+91-1792-230541, 230767, Fax:+91-1792-231207
Membership Form (for join as new Member)
1. Name (in block letters) :__________________________________
2. Full postal address :__________________________________ __________________________________ __________________________________ __________________________________ Telephone No.(O) __________________ (R ) ______________________ E.mail address: FAX: MOBILE:
3. Profession :__________________________________
4. Date of Birth :__________________________________
5. Educational Qualification:______________________________
6. Nationality :__________________________________
7. Permanent Address :__________________________________ (Residential) __________________________________ __________________________________ I ______________________ request you that I may be registered as Annual/Life/Patron Member of Mushroom Society of India. I am remitting an amount of Rs./US $ _________ (Rupees/US dollars _________ ____________________only) by Demand Draft as Membership fee in favour of Treasurer, Mushroom Society of India payable at Solan. Date: Signature of Applicant Place: Subscription Rates Indian Foreign Annual* Rs.500.00 US $50 ($25 FOR SAARC Countries) Life Rs.4000.00 US $500.00 Patron Rs.10000.00 US $1000.00 Library** Rs.1200.00 US $150.00 To be renewed by paying Rs.300/- or USD100 after expiry of one year. To be renewed by paying Rs.600/- or USD150 after expiry of one year.