THE NURSING SCHOLAR SOCIETY (N.S.S.

)
HALL OF FAME
(Patron/Senior Advisor Dr. Suwersh Narula-Khanna)

Open to all Nurses (ANM, GNM, B.Sc. (N), P.B .B.Sc. (N). M.Sc.(N) & PhD). Show or learn
scholarly activities and get recognized along with many COVID19 frontline hero nurses.

MEMBERSHIP CATEGORY (Tick One):

General Life Member: (1,000 RS.)

President's Circle Life Member: (3,000 RS.)
Patron/Advisor Life Member: (50,000 RS.)
Student Member: (500 Rs.)

Name: Dr., Mrs., Miss or Mr.

Permanent Address: Street
City, Town, Country, Postal
Code
Date of Birth
Telephone – Mobile
Telephone – Home, Office
Email
Professional Status
(Working/Retired/Other)
If Working, Job Title &
Employer

CORRESPONDENCE ADDRESS: President The Nursing Scholar Society, Crystal Apartment, 2G B2B, 203
opposite SRPcamp, Second Ring Road, Rajkot, Gujarat 360006
Email: thenursingscholarsociety@gmai.com
binu_joe@rediffmail.com
Mobile: 91 78695 23896
PAYMENT DETAILS: As per membership category, you can do payment either by Net banking as per below
details or by scanning the given image:
 Account holder: The Nursing Scholar Society
 Account No: 50100420483323
 IFSC: HDFC0003513
 Branch: Haripar, Rajkot, Gujarat 360006

OFFICE USE ONLY:

Name, Type of Membership,
Receipt Number
Issued/Allotted/Signed By
and Designation
Membership Card Issued On