APPLICATION FOR MEMBERSHIP (Balvant Parekh Centre for General Semantics and Other Human Sciences

                                                                   C-302 Siddhi Vinayak Complex, Faramji Road, B/h Baroda Rly. Station, Baroda-390007)

1

Name

 

2

Address for communication

 

 

 

 

3

Telephone No.

 

4

Mobile No.

 

5

E-mail ID

 

6

Institutional Affiliation

 

 

7

Areas of Scholarly Interest

 

 

8

Date of Birth

 

9

Educational Qualifications

 

10

Major Publications, if any

 

11

Names and Addresses of Two References

1st Reference

 

 

 

 

2nd Reference

12

Type of Membership Desired

 

13

Any other relevant Information

 

 

 

14

Demand Draft No. & date

 

Note: Please send DD only drawn in favour of BALVANT PAREKH CENTRE FOR GENERAL SEMANTICS AND OTHER HUMAN SCIENCES payable at Baroda

         (any bank's DD having branch in Baroda; issuing branch and drawee branch should be the same)