THE BOTANICAL SOCIETY OF ASSAM REGD. NO. 1218 of 1993-94 (Under Act. XXI of 1860) (A Society for uniting Botanists and promoting advancement of Botanical interests) To The Secretary Botanical Society of Assam Dear Sir, I desire to become a life/annual member of the Botanical Society of Assam. I have remitted the membership fee and the admission fee of Rs………………… through cash/DD No………………………….……Dated……………… drawn in favour of Botanical Society of Assam, Payable at Guwahati. Yours Sincerely Place: Date :

…….……..………….. Name (in Block Letter) :……………………………………………………………… Date of Birth

:………………………………………………………………

Academic qualification :………………………………………………………………. Special interest, if any :………………………………………………………………. Research Interest, if any :………………………………………………………………. Institute

:………………………………………………………………

Address :……………………………………………………………… PIN:…………………….. Telephone No. (Res.)……………………..(M)…………………... Email: ………………………………………………………………………………………...(mandatory) 1. Admission fee : 2. Annual membership fee: 3. Life membership fee : 4. Student membership fee:

Rs. 50.00 Rs. 500.00 Rs. 3000.00 Rs. 250.00

NB: The duly filled up membership form may be sent to “Prof. P. P. Baruah, Secretary, Botanical Society of Assam, Department of Botany, Gauhati University, Guwahati-781014, Assam (India) or “Dr. M.R Nath, office secretary, Botanical Society of Assam, A.C. Dutta Bhawan, Department of Botany, Cotton College, Guwahati-781001, Assam (India). *Payment may be done in cash or Draft in favour of “Botanical Society of Assam” or may be deposited to SB A/c No. 10823642495 at SBI, Guwahati Branch, Panbazar