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  Member's Registration  
 
Membership Form
   
Membership type *
Name *
Father's Name *
E-Mail Address *
Mobile Number * +91-  (use only 10 digit mobile number)
Telephone Number
Address
(maximum 200 characters)
Occupation
Designation
Organization
 
Educational Qualification
College/University Course Year of completion
   
Training / course relevant to Stress Management
Organization Course Duration (days) Date of completion
  Dates must be entered in the format dd/MM/yyyy
Example: 12/01/2000 for 12th January 2000
Declaration
i certify that all information provided in the above application is correct to the best of my knowledge and that i will abide by the ISMA-India code of conduct. I enclose my non refundable administration fee Rs.150/-  and any relevant certification eveidence.
   
Signature Name Date
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