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:

Association Correction Form
Enclosed: Aadhar card, photo. Association Certificate and Identity Card, Correction fee.

Membership fee Rs. 300/-
Renewal fee Rs. 150/, Correction fee Rs. 100/-
Post office Charge WB, Rs. 50, others- 100/-

FOR I.A.E.A.M. OFFICE USE ONLY
ADDRESS:

Head Office: Delhi- 13

Regional office: Kolkata- 124

Developer officer: 7063022919
Developer officer: 9064902955

I.A.E.A.M.
Rural Development officers.

President- 8759612504, Secretary: 7432953522