The Association of Sri Lankan Neurologists
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Association of Sri Lankan Neurologists
C/O Ceylon College of Physicians
341/1, Kotte Road,Rajagiriya, Sri Lanka
Telephone: 2888146 Fax: 2888119
 
Application for Membership
 
For the online Payments : Please open this site using Internet Explore
I hereby apply for membership of the Association of Sri Lankan Neurologists.I agree to abide by the constitution of the association and to pay my subscription fee set by the council
 
     
  Name of candidate  
  Qualifications  
 
Position
 
 
Institution
 
 
Address for correspondence
 
 
Country
 
 
Personal telephone No
 
 
Office telephone No
 
 
Other telephone No
 
 
Mobile
 
 
E-Mail
 
 
Password
(Please enter password that you would like to have)

 
 
Confirm Password
 
  Date  
   
  Membership Fees :
       
  Payment method  

(Online Payment Available)

       

The below mentioned annual membership fees will apply.

USD 5
Ordinary members USD 10
USD 100
USD 25
Overseas/Foreign member Lifetime Membership USD 250
       
  ** Life membership in each category, would amount to ten (10) years of annual fees.
  ** Life membership category will not apply for Associate members.
   
 
*The registration fee can be paid by a bank draft made payable to
'The Association of Srilankan Neurologists Bank of Ceylon, Regent Street, Colombo 10, Sri Lanka'.
Bank draft number
Name and address of payee bank
 
     
       

 

 

 
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