KGAPA Membership Form

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KERALA GOVT: AYURVEDA PHARMACISTS' ASSOCIATION

Central Committee, Thiruvananthapuram (Reg. No. 202/78)

Form No: 1 Part A

( APPLICATION FOR MEMBERSHIP )

1. Name

2. PEN

3. Official Address with Designation

4. Date of Appointment

5. Pay & Scale of Pay

6. Age and Date of Birth

7. Qualification

(a) General

(b) Technical

8. Permanent Postal Address with Pin code

9. Phone Numbers (Mob. & Land)

10. E-mail ID

I do hereby agree to abide by the by-laws of the Association and to act according to the decision of the Association.

Remarks of the Dist. Committee

1. Name of District

2. Date & Decision number of Dist Committee

3. Admission No

4. Remarks

5. Date

President / Secretary