Membership Application

I. Applicant Details

First Name* Last Name* Street Address* Pin* Telephone (Residence) Mobile* Email* Date of Birth*

II. Qualification

Degree University Year

Attested copy of degree certificate

III. Experience

Appointment Institution Period % of Work in Echocardiography

Attested copy of proof of experience

IV. Training Course in Echocardiography (if any) :

Institution Period Type of Training / Course

Attested copy of course certificate

V. Membership of other Societies (specify) :

Specification

Whether a member of Indian Academy of Echocardiography*

VI. Publications & Research

Upload details of publications (if any) with title, names of all authors, Journals, vol., page, year

Upload research work to Cardiovascular system with special reference to echocardiography (if any)

VII. Type of membership*

VIII. Proposers*

Name of Proposer* Email of Proposer* Name of Seconder* Email of Seconder*

I. Applicant Details

First Name* Last Name* Street Address* Pin* Telephone (Residence) Mobile* Email* Date of Birth*

II. Qualification

Degree University Year

Attested copy of degree certificate

III. Experience

Appointment Institution Period % of Work in Echocardiography

Attested copy of proof of experience

IV. Training Course in Echocardiography (if any) :

Institution Period Type of Training / Course

Attested copy of course certificate

V. Membership of other Societies (specify) :

Specification

Whether a member of Indian Academy of Echocardiography*

VI. Publications & Research

Upload details of publications (if any) with title, names of all authors, Journals, vol., page, year

Upload research work to Cardiovascular system with special reference to echocardiography (if any)

VII. Type of membership*

VIII. Proposers*

Name of Proposer* Email of Proposer* Name of Seconder* Email of Seconder*