NEWS LETTER - INDIAN ASSOCIATION OF PHYSIOTHERAPISTS - MAY, 2019
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NOMINATION FORM (IAP ELECTION 2020-2023) CENTRAL/STATE
NAME: _______________________________________________________________________
(FIRST NAME) (MIDDLE NAME) (SURNAME)
LIFE MEMBERSHIP NO: __________________________________________________________
ADDRESS: ____________________________________________________________________
CITY: _____________STATE:___________________________PIN CODE:__________________
EMAIL:___________________________________________MOBILE NO:_________________
POST: ________________________________________________
SIGNATURE OF CANDIDATE DATE:
PROPOSED BY:
NAME:_______________________________________________________________________
(FIRST NAME) (MIDDLE NAME) (SURNAME)
LIFE MEMBERSHIP NO: __________________________________________________________
ADDRESS: ____________________________________________________________________
CITY: _____________STATE:___________________________PIN CODE:__________________
EMAIL:___________________________________________MOBILE NO:_________________
POST: ________________________________________________
SIGNATURE OF CANDIDATE DATE:
