To the President-
Through the General Secretary Central Union. Delhi- 13
And Regional office, Kolkata- 124, West Bengal.
Respected Sir / Madam.

I beg to apply for a Membership / Renewal of- I.A.E.A.M. Kolkata- (INDIA), I do hereby declare that I shall be bound to abide by the rules & regulations of the Association, Further, I Like to declare that I am not a member of any others Medical union. The particulars as may be required are given bellow: