GWALIOR ACADEMY OF MATHEMATICAL SCIENCES

 

           Present Office: Sagar Institute of Research, Technology & Science,

         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