Indian Fertility Society | Fertility Science & Research · Web viewINDIAN FERTILITY SOCIETY...
Transcript of Indian Fertility Society | Fertility Science & Research · Web viewINDIAN FERTILITY SOCIETY...
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INDIAN FERTILITY SOCIETY
Nomination Form
For the post of IFS Office Bearer-1St April 2018 to 31st March 2020
To The PresidentIndian Fertility Society Secretariat:Akanksha IVF CentreA-3/7, Janak Puri,New Delhi-110058
Name of Candidate:……………………………………………………………………………………………………………………………………
Post Applied for:…………………………………………………………………………………………………………………………………………
Name of the Proposer:………………………………………………………………………………………………………………………………1. …………………………………………………………………………………………………………..Signature…………………………………………………2. …………………………………………………………………………………………………………..Signature…………………………………………………3. …………………………………………………………………………………………………………..Signature………………………………………………… 4. …………………………………………………………………………………………………………..Signature………………………………………………… 5. …………………………………………………………………………………………………………..Signature………………………………………………… Seconded by 1. …………………………………………………………………………………………………………..Signature………………………………………………… 2. …………………………………………………………………………………………………………..Signature………………………………………………… 3. …………………………………………………………………………………………………………..Signature…………………………………………………4. …………………………………………………………………………………………………………..Signature………………………………………………… 5. …………………………………………………………………………………………………………..Signature………………………………………………… Declaration –I am a member of the society since ………………………. (IFS membership number - …………………………) and above served on the Executive Committee of IFS in the following capacities.Post (S) Tenure Year
1. From To2. From To3. From To4. From To
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5. From To
I, Dr. ……………………………………………………………………………………………………………………………………………………………………………… declare that the above information is correct to best of my knowledge.
Signature:………………………………… Date: …………………………………