Membership Form

Rajasthan Sociological Association

The Secretary, Affix

Rajasthan Sociological Association your recent

Jaipur Photograph here

Sir,

I would like to be a Life Member (Rs.3500/-or the revised fee, whichever is in force) or Research Scholar/ Student Member (Rs.700/- or the revised fee, whichever is in force) for one year……….OR Institutional Member (Rs.10000/-or the revised fee, whichever is in force) of Rajasthan Sociological Association and remit Rs………………….. by Cash/Bank draft/NEFT in favour of the Secretary, Rajasthan Sociological Association payable at Jaipur.

Date: Yours faithfully

Place:

(Signature of the Applicant)

1. Full Name in Block Letters: ____________ _______________ _____________

(Surname) (First Name) (Middle Name)

2. Date of Birth: __________________________________________

3. Mailing Address: __________________________________________

__________________________________________

4. Permanent Address: __________________________________________

__________________________________________

Mobile No. __________________________________________

E-mail: __________________________________________

5. Name of the College/University/Institution: _____________________________________

in which working as __________________________________________

6. Subject: __________________________________________

7. Teaching Experience (Years) __________________________________________

8. Publication (Enclose list) __________________________________________

For Office Use Only

Application Received on ………………………….. Payment Received on ……………….... in Cash/by DD No./NEFT UTR No. …………………… of Rs. …………..… Bank Slip No… … … Date…………………and Approved by the RSA EC on ……………LM No./ SM No. ……………..

Secretary Treasurer

# The membership fee may be remitted by Cheque/DD drawn in favour of the Secretary, Rajasthan Sociological Association, Jaipur. Fee can also be electronically transmitted through NEFT /RTGS as per following details: IFSC Code – ICIC0006747, MICR Code – 302229018, Bank Name – ICICI, Branch – Bapu Nagar, University Campus, Jaipur; Bank Account No. 674701414661.The Membership Fee is non-refundable.

## Dully filled up form should be sent in hard copy on either of the following addresses:

i. Current Secretariat: Tribhu Nath Dubey, Department of Sociology, Govt. Arts Girls College, Nayapura Kota – 324001

emaiil: tndrsaj@gmail.com , rsa.rajpr@gmail.com ) 9413161532

ii. Treasurer’s Contact: Dr. Mahesh Nawria, A-87, Hida Ki Mori, Near Bajrang Nursery, Mandi Khatikan, JAIPUR 302 002 (Raj)

email: m.nawria@gmail.com ) 09461280093, 09928580093