Name Nationality Place of Birth Date Of Birth A. Office Address B. Home Address Cell Phone Email Present position, Length of Service and Responsibilities: Nature of experience and interest in Biomedical Engineering including publications:(Attach additional sheets if necessary) Heighest Education (Degree) Year of passing Membership of other professional organisations: Date D D/ NEFT No Bank Amount Attach Resume: I certify that the statements on this application are correct and agree to abide by the rules and bylaws of the society. Demand Drafts should be made payable to the BIOMEDICAL ENGINEERING SOCIETY OF INDIA, payable at Manipal. Completed application form together with Demand Draft should be sent to: Dr. G. M. Bairy, Secretary, BMESI, Professor and Head, Department of Biomedical Engineering, Manipal Institute of Technology, Manipal - 576 104. Submit Reset
