Annual Membership
Rs. 100/-
  5 years Membership
Rs. 500/-
  10 years Membership
Rs. 1000/-
  Life Membership
Rs. 2500/-
  Gold Membership
Rs. 5000/-
  Patron Membership
Rs. 10000/-

 

The Executive Board
India Renal Foundation
Ahmedabad

Dear Sirs,

I wish to become Annual / Life / Patron member of India Renal Foundation. I have gone through the details of the membership and agree to abide by them.

I send the below mentioned by cheque / cash being Annual / Life / Patron membership subscription.

I agree that the Executive Committee’s decision on my membership request shall be final and binding on me. I give below the required particulars for the consideration of the committee.

 
 
   
Amount
Name (in full)*
Residence Address*


City*
Phone*
Mobile
Email
Organisation*
Designation
Office Address
City
Phone
Academic and professional qualifications
 
Fields of Interest
   
   
 

* Required

Please name all your payments to
India Renal Foundation payable at Ahmedabad, India.
60-61, A Wing, Nobles, Opp. Nehru bridge, Ashram Road, Ahmedabad 380 009, India.
Phone : +91-79-658 4251  Fax : +91-79-658 7042
Email : irf@indiarenalfoundation.org   www.indiarenalfoundation.org