Scribd
Upload
85 views1 page

IPA Student Membership Form

The document is a membership application form for the Indian Pharmaceutical Association. It requests information such as name, date of birth, contact details, and educational institution from applicants. It also lists the fees for different membership types and subscriptions.

Uploaded by

mail4sathesh2000
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
85 views1 page

IPA Student Membership Form

The document is a membership application form for the Indian Pharmaceutical Association. It requests information such as name, date of birth, contact details, and educational institution from applicants. It also lists the fees for different membership types and subscriptions.

Uploaded by

mail4sathesh2000
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

THE INDIAN PHARMACEUTICAL ASSOCIATION (IPA)

Membership Application Form


For Student membership PHOTO
Kalina, Santacruz (East) Mumbai 400 098
Tel: 022 2667 1072 Fax: 022 2667 0744
Email: [email protected]
Website: ipapharma.org
To Date:
Hon. Gen. Secretary,
The Indian Pharmaceutical Association
Sir,

I hereby apply for the Student Life / Student membership of the Indian Pharmaceutical Association and undertake
that on admission, I shall abide by the rules and regulations of the Association.
Signature of the
Applicant

Full Name (In Capital letters)


Date of Birth (DD/MM/YYYY)
Blood Group

Mailing address:

Contact Details: Phone Number :


Mobile Number:
Email ID:

Type of Membership Student Life / Student


Name and address of the Institution

Contact details
Endorsement from the Institute Certified that Mr. /Ms
is a student of this institution and is studying in the year of
Pharm D / B. Pharm / D Pharm Degree / Diploma

Seal of Institute Signature of the


Principal
Details of Remittance: By Cheque/DD Admission Fee Rs.
In favor of “Indian Pharmaceutical Membership Fees Rs.
Association” payable at Mumbai IJPS Subscription Rs.
Add: Bank charges – For outstation Bank Charges Rs.
cheques GST @ 18% Rs.
Note: For Membership fees and IJPS
subscription refer tables given below Total Rs.

Cheque /DD No & Date:


Drawn on :
For office use
Membership No
Date of Admission Hon. Gen. Secretary

You might also like