Dear/Sir Madam,

I wish to apply for membership of "THE AIIMSONIANS". My particulars are as under:

Name (in caps)                         :

Date of Birth                             :                                 Gender : Male/Female

Category Eligible (See below)     :                                                         Type of membership Eligible :Full/ Guest

First Degree / Course / Job Pursued at AIIMS/ (Please attach proof)                         Faculty of AIIMS: No / Yes

Month & Year of entry at AIIMS :                                                           For MBBS Alumni - Batch No. : ____________

                                                                                                                                       Roll No. : _____________

Full Postal Address:

(with Pin Code)                                                                                     Specialise in          1. _____________________

                                                                                                                                       2. _____________________

                                                                                                                                       3. _____________________

Currently residing in (County) : ______________________________

TELEPHONE NO.:  Work Place:____________________________________ Residence : ___________________________

Fax No. __________________________ Email:: _______________________ Cell-Phone: ___________________________

Spouse & Children's Name :

Spouse : (Name)___________________________________ Children : (Names)____________________________________

Marriage Anniversary_______________________________

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*    Please add Rs. 20/- for cheques from outside Delhi.

*    The Cheques/ DD should be drawn in favour of  "the AIIMSONIANS" and should be crossed.

*    Please return this form with:    "The AIIMSONIANS" Office, Room No. 38A. Pre-clinical Block

     one extra photo graph to           AIIMS, New Delhi - 110029. E-mail :  birsingh43@hotmail.com

                                                    Phone No. :26594461,2 6594985        Fax : 011-26862663

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Important Excerpts from the Constitution of "The AIIMSONIANS"

4.    MEMBERSHIP of The AIIMSONIANS :
Members will be enrolled only as life members. Members enrolled at the Head Office of the AIIMSONIANS shall be know as primary members. Type of Life Membership will be as follows:

4.1.  FULL MEMBERSHIP : The following are eligible for full membership. On becoming full members, they are entitled to call themselves "Members of The AIIMSONIANS.

4.1.a    Group A: shall comprise :

A1*    Those who have completed any postgraduate medical/ paramedical course from AIIMS (MD, MS, PhD, MSc, DM, MCh, MHA,            MDS etc.

A2*    Faculty of AIIMS (past or present) who have held a regular job at the Institute.

A3*    All those who have completed a undergraduate medical/paramedical degree/ diploma course at AIIMS.

A4*    Anyone who has asked for at least 3 continuous years in an academic medical job at AIIMS.

4.1.b   Group B shall comprise medical graduates (MBBS) of AIIMS

4.2.    GUEST MEMBERSHIP

          Open to any one (including Indian/Foreign visitors) who has worked/participated in any academic activity at AIIMS for a continuous period of at least six months but is not eligible for full membership. (Please attach proof).

          Such member will be called the "Guest AIIMSONIANS".

4.3.    MEMBERSHIP FEES : (Revisable)

         Currently :

         -Indian Rs. 1,500/- for Indian Residents

         -U.S. Dollars  75/- or Indian Rs. 3,000/ -for residents of other SAARC countries

         -U.S. dollars 300/- for all others

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7.    EXECUTIVE COMMITTEE :

7.1  COMPOSITION :

       It shall consists of 6 office bearers (1. President, 2 Vice Presidents. 1 Secretary cum Treasurer, 2 Joint Secretaries)         and 10 Executive Committee Members (6 elected from Group B as in clause 4.1.b, i.e., medical graduates (MBBS) from         AIIMS and one each elected/ co-opted from amongst Group A as in clause 4.1.a.,i.e., Groups A1, A2, A3, A4).

       Only Group B members (as in clause 4.1.b) can hold the posts of office bearers of the Executive Committee.

       Guest members have no voting rights in the elections/ meetings of "The AIIMSONIANS" but enjoy all other rights of          a full member.

       I have read and understood the rules as above and promise to abide by them

Date : _______________________________                                                 Signature : _____________________________

                                                                                                                 Name : ________________________________

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Membership Category :_______________________

FOR OFFICE USE ONLY

Receive Rs. _______________________________________________/-by Cash/D.D./Cheque* No.

___________________________

drawn on Bank : _________________________________________________________________________________________

Receipt (Issued) No. ______________________________

I. Card issued on : ________________________________________

Date ________________________________                         (*Subject to realisation)                                            Dr Bir Singh
Secretary
The AIIMSONIANS