Scribd
Upload
106 views1 page

National College of Chest Physicians (India) : NCCP Directory Entry Form

The document is a form for members of the National College of Chest Physicians (India) to provide updated contact and credential information to be included in the organization's directory. It requests information such as name, address, contact details, degrees earned, specialties, and affiliations in order to correctly list members. Completed forms should be sent to the specified contact to update the directory listing.

Uploaded by

Nishtha Singhal
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
106 views1 page

National College of Chest Physicians (India) : NCCP Directory Entry Form

The document is a form for members of the National College of Chest Physicians (India) to provide updated contact and credential information to be included in the organization's directory. It requests information such as name, address, contact details, degrees earned, specialties, and affiliations in order to correctly list members. Completed forms should be sent to the specified contact to update the directory listing.

Uploaded by

Nishtha Singhal
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 1

National College of Chest Physicians (India)

(Formerly Indian Association for Chest Diseases)


V.P. CHEST INSTITUTE, UNIVERSITY OF DELHI, DELHI-110007.

Ref No: NCCP (I) Secy./Directory/ Dated:…………………..


Regd No.:S/1421 (1981)

NCCP DIRECTORY ENTRY FORM


1. Please use Capital Letters or Type.
2. Please mention your Membership / Fellowship number for all future correspondence with College.
3. All correspondence and the IJCDAS (Journal) will be dispatched at your Mailing address.
4. Filled applications to be sent to Prof. S.N.Gaur, GAUR Clinic, 130-A, Patparganj Village, Delhi – 110091.
Membership/ Fellowship No. MembershipYear FellowshipYear

Surname
First Name
Middle Name
Date of Birth:
D D M M Y Y Y Y
Present
Designation
&
Organisation:

Permanent
Address: City
State PIN

Mailing
Address: City
State PIN
Telephone (with Area Code)
Residence: Office:
Fax: Mobile:

E-mail Address:

Degrees:

Affiliation to
other Scientific
Bodies:
1 2
Specialties:
3 4

Interest Section:

Spouse Name:

Spouse Profession:
* Please let us know about any other information / suggestion or out of date information printed in the last Directory.
** Enclose any other information to be added in the Directory on a separate sheet.

You might also like