Apply for Membership

2. Personal details

Title *

Family name *

First name *

Sex *

Date of birth *

Nationality *

3. Qualifications and designation

Academic qualifications with year *

Designation *

4. Official address

Department

Institution

Address

District

Zone

Telephone (with area code)

Mobile

5. Residential address

Address

District

Zone

Telephone (with area code)

Fax (with area code)

Mobile

Preferred address for communication

OfficialResidential

6. Professional experience

Teaching (years)

Research (years)

Diagnostic (years)

Brief description

7. Field of expertise / areas of interest

Area of interest (1)

Area of interest (2)

8. Publications and other memberships

Publications, if any

Attach list of publications (optional)

Membership of other professional bodies, if any

Any other relevant information

9. Payment details

Bank voucher / receipt no.

Date

Bank

Branch

Amount (Rs.)

Enclose the bank voucher for the appropriate amount drawn in favour of “Nepalese Association for Clinical Chemistry.” Himalayan Bank Limited, Maharajgunj, Kathmandu — A/C No: 002-05202190-015.

10. Declaration

I have gone through the statute of the Nepalese Association for Clinical Chemistry. If admitted as a member, I shall abide by the rules and regulations of the NACC. *

Disclaimer: publish my address and full details on the NACC website

I have no objectionI object

A current NACC member must recommend your application. If you don’t already have one, the secretariat will help match you with a recommending member after you submit this form.

Download PDF instead

Membership application form.