GWALIOR ACADEMY OF MATHEMATICAL SCIENCES

         Ayodhya Byepass Road, Post Ayodhya Nagar, Bhopal-462041

APPLICATION FORM FOR LIFE/DONOR MEMBERSHIP

Name

Date of Birth

Designation

Address (Official)

Phone                                                       Mobile

Email

Address (Residential)

Phone  No.

Qualifications

Details of Research Publications

Areas of Interest

Type of   Membership                               

                             i.       Normal Life Membership                                                                                       5,000/-

                            ii.       Life Membership for Sr. Citizens (above 60 yrs.)                                                 3,000/-

                          iii.       Corporate membership (free participation of two representatives)                       20,000/-

                          iv.       Foreign members (other than SAARC Countries)                                               US$   300/-

Any other Details

Date                                                                                                                 Signature

For Official Use

Received……………………………….by cash / Cheque / Bank draft No……………………………………….                                                   

Dated……………………………………..towards Life / Donor membership of GAMS.

Date                                                                                                                 Signature

*Note-DD should be payable to Gwalior Academy of Mathematical Sciences, Gwalior