LSI Membership Form

Name: __________________________________________________

Position: __________________________________________________

Department: __________________________________________________

Organization: __________________________________________________

Address: __________________________________________________

_____________________Postcode: __________________

Telephone: Office_________________________________________

Telephone: Res._________________________________________

Email: __________________________________________________

Qualifications: __________________________________________________

Limnological interests: __________________________________________

Membership Subscription Rates for 2006

• ____ Ordinary Membership (Annual) Rs. 200/-
• ____Life Membership Rs. 2000/-

Method of Payment:( payable at Chennai in favour of Dr.V.Sivasubramanian)

• __ Money Order
• __ DD

Signed: ____________________________ Date: _____________________

Filled forms may be sent to The Treasurer or The Secretary, LSI