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Indian Naturopathy & Yoga Medical Association 

Indian Naturopathy & Yoga Medical Association

 

 

 

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(Under the auspices of Board of Naturopathy and Yoga Systems of Medicine)

Headquarters:  Ganga Bhogpur Rishikesh  UK

Tel: 09359922777; Email: inyma247@gmail.com

website: www.inyma.yolasite.com

                                               

 APPLICATION FORM FOR LIFE MEMBERSHIP

 

 

 

Dear Sir,

I hereby apply to be elected a Member/Associate Member/Overseas Member/Life Member of I.N.Y.M.A.

. My particulars are given below:

 

I have  understood  rule and regulations of the I.N.Y.M.A. and, if elected as a member, I agree to abide by the same.

 

Place…………………………..

 

Date……………………………                                                                                                ………………………….

                                                                                                                                    Signature of the applicant

1. Name in Full

(Block Letters)……………………………………………………………………………………………………......

1. Date of Birth…………………3. Sex…………….. 4. Name of Father/Husband…………………………………....

  5.         Postal Address………………………………………………………………………………………………………..

        ……………………………………………………………………………………………………………………….

  6.        Land Line No …………………………………………Mobile No………………………………………………….

  7.        Email ID………………………………………............................ 8. Demand Draft No…………………………….

  9.        Name of the Bank…………………………….................. (The Life Membership fee of Rs. 1000/- To be drawn in f/o Sukhsagar Education Society  payable at Meerut)

10.       Qualifications:

Degree/Diploma                                   University/Institution                           Year Obtained

  i.                  ……………………………….                   ………………………………. .                ……………………………

1. ……………………………….                …………………………………             …………………………….

Please enclose photo copies of  any Membership/Degree, Post Graduate & Diploma/Degree/copy of  Medi/ CMO registration

 

11. Experience:

Designation                             Institution                                           Period: From To

1. …………………………..          …………………………..              ……………………………………
2. …………………………..          …………………………..              ……………………………………

 

 

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If the space provided under any item is inadequate use additional sheets/s

 

1.  (a) Membership of Medical Associations:

             National/International                                    1………………………………………………………….

                                                                                  2………………………………………………………….

        (b) Membership of other Organisations:             1………………………………………………………….

                                                                                 2…………………………………………………………..

1. Prizes, Medals, Awards etc.

        Under-graduate/PG/After PG Level                  1……………………………………………………………

                                                                                   2…………………………………………………………… 

       National or International awards:                       1……………………………………………………………

                                                                                   2…………………………………………………………….

1. Publications:

Title                             Name of co-authors if any                    Name & Issue of Journals

………………………….         ..………………………………….       …………………………………………..

………………………….         …………………………………...       …………………………………………..

1. Any other information:

       …………………………………………………………………………………………………………………

       …………………………………………………………………………………………………………………

Recommended and forwarded to the Honorary Secretary, IN.Y.M.A, Utterpradesh.

…………………………. Honorary Secretary                                   ……………………….. Honorary Secretary

…………………….…… Branch Chapter                                          ……………………….. State Chapter

Date ………………..

FOR HEADQUARTERS USE ONLY

 

Application received on ……………………………………………….

Category of Membership applied for:

MEMBER / ASSOCIATE MEMBER/ OVERSEAS MEMBER / LIFE MEMBER

Membership approved on………………………………………..

Membership No………………………………………………….

 

 

 

 

 

                                                                                                                       Honorary SecretaryI.N.Y.M.A.

                                                                                                                                  Head Quarters, Haridwar

 

 

Please strike out whatever is not applicable.