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Registration Form for HEF Life Membership

1. Name :
2. Designation :
3. Organization :
4. Correspondence Address:

5. Mobile number :
6. Landline Number :
7. E-Mail ID (Personal) :
8. Membership Type : Academic / Corporate (Tick on appropriate type)
9. Payment Details
Cheque / DD Number :
Date :
Amount :
Favoring : ‘Higher Education Forum’ payable at Mumbai

Signature

The two categories of membership:

a. Life membership (corporate): Rs 6,000/- for corporate professionals / consultants

b. Life membership (academic): Rs 3,000/- for faculty members

Note:

 For retired persons, the membership subscription payable is 50% of the above.

 Payment made by cheque will be subject to realization. Only Demand Draft will
be accepted from outstation (out of Mumbai) candidates.

Please send your registration form along with the remittance to:

Dr A K Sen Gupta
Founder & Convener – HEF
Flat 1:, Deeya Apartments
Plot-53, Sector-19
Nerul (East)
Navi Mumbai- 400706

Mobile no. 98211-28103