To the Head of Executive Committe of Society of Pharmaceutical Sciences
of Ankara,
I want to be a member of your society. I have paid my subscription fee
to the bank account of Society of Pharmaceutical Sciences of Ankara on
Turkiye Is Bankasi Gazi Mahallesi Subesi account number 4286 304400 201434.
I
am submitting to you information and to deal with my application.
DATE:
NAME-SURNAME:
FATHER
NAME
MOTHER NAME:
NATIONALITY:
PLACE OF BIRTH:
DATE OF BIRTH:
HOME ADDRESS:
BUSINESS ADDRESS:
OCCUPATION:
BUSINESS
PHONE:
HOME PHONE:
CELLULAR
PHONE:
E-MAIL:
EXPERIENCES:
TITLE:
DATE OF
START:
IDENTITY NUMBER:
SOCIAL SECURITY NUMBER:
PROVINCE:
COUNTY:
VILLAGE-DISTRICT:
VOLUME
NUMBER:
FAMILY NUMBER:
INDIVIDUAL NUMBER:
PLACE OF GIVEN:
DATE OF GIVEN:
VIEWS AND SUGGESTIONS:
The persons
who want to be a member of society, must fill in the form above and
submit via e-mail and;
a) Provide
2 photographs
b)
Photocopy of Identity Card
c) The bank
receipt of payment of the 2011 subscription fee which was paid on bank
account of Society of Pharmaceutical Sciences of Ankara on Turkiye Is
Bankasi Gazi Mahallesi Subesi account number 4286 304400 201434.
All these
documents must be submit to mailing address of executive committe.
Prof. Dr. Bensu KARAHALİL President
Gazi
University Faculty of Pharmacy
Department of Pharmacetical Toxicology Ankara
