THE CHEMICAL SOCIETY OF PAKISTAN

(Registered Address: The Department of Chemistry, Quaid-i-Azam University, Islamabad)

Email: ccccsqau@gmail.com | http://chemicalsocietyofpakistan.com

APPLICATION FOR MEMBERSHIP PARTICULARS OF THE APPLICANT FOR MEMBERSHIP

I desire to be Life member/Annual member/Student member of the chemical Society of 1) Full Name: Dr./ Mr./Miss/Mrs….…………………..………..……………………
Pakistan and agree to abide by the rules, regulations and traditions of the Society.
2) Father’s name: ………………………………………………………………….....
A bank draft/pay order no:………………of Rs:………..… is being enclosed herewith in 3) Telephone (Off.): ……………….……....Telephone (Res.): ……………..……....
connection with my life membership/annual membership/student membership for the year
…………………… Mobile No.:……………….………….… Fax No: ………………….................…
I also wish to contribute Rs. ……... as donation for various academic activities of the Email: ……...…....…………………………………………………………..…….
Chemical Society of Pakistan. 4) Mailing address:……………………………………………………………...……
Undertaking: I undertake to abide by all the rules, regulations and traditions of the ………………………….……………………………………………………….…
society as available in the constitution and generally practiced respectively and in case of
a disagreement the ruling of the President CSP shall be the final and I shall not challenge 5) Permanent address: …………………………………………………………....….
it in any court of law. ……………………………………………………………………………..........…

Signature: ………………………………....................... 6) Job title: ………………………………………………………………………...…

Name: …………………………………..…………..… 7) Profession with Experience: ……………………………………………………...

(In block letters) 8) Academic Qualification: ……………………………………………………….....
Photograph Date of Birth: ……………………………………….… 9) Field of interest: ……………………………………………………………...…..
Gender: Male, Female Nominated by:………………..………..……... Membership No:………..….……..……
CNIC: ………………………………………………… Action taken by the Council: ………………………………………………….........……
Dated: ………………………………………………… Membership No. Assigned: …………..….…… Accepted on: ……..…….…….........…

Membership Subscription Fees*

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PRESIDENT SECRETARY GENERAL TREASURER
Accepted, in general, through bank draft/pay order only. You may also pay online in
account No. 2947901225303, Habib Bank Limited, Quaid-i-Azaum University,
Islamabad. Title of account being The Chemical Society of Pakistan. Please return to any one of the following:

Life membership: Rs: 5000.00 Annual membership: Rs: 500.00 1. Prof. Dr. Ghulam Abbas Miana, President CSP, Country Coordination Centre in Chemical
Five yearly membership: Rs: 2000 Student membership: Rs: 200.00 Science (CCCCS), Department of Chemistry, Quaid-i-Azam University, Islamabad.
Overseas (Life): US $: 200.00 Overseas (Annual): US $: 20.00 2. Dr. Muhammad Raza Shah Secretary General CSP, HEJ research Institute of Chemistry
University of Karachi, Karachi 75270.
(Important Note: Membership to be effective from the date of issue of the Membership Card). 3. Vice President of the Local Chapter for onwards transmission the central office or to the
Secretary General CSP.
THE CHEMICAL SOCIETY OF PAKISTAN
(Registered Address: The Department of Chemistry, Quaid-i-Azam University, Islamabad)
Email: ccccsqau@gmail.com | http://chemicalsocietyofpakistan.com