Form Lifetime Membership

A/C Title: Pakistan Nuclear Society

IBAN: PK18NBPA1725004018982691

Bank: National Bank of Pakistan (NBP)

Branch: Margalla, Islamabad

Lifetime Membership Form

Title*
- Dr.
- Mr.
- Ms.
Full Name (without abbreviations, e.g. M., S. etc.)*
Date of Birth:*

YYYY
MM
DD
CNIC*
Highest Academic Qualification with Year of Award:*
Field of Specialization:*
Designation (Present/at the time of retirement for retired person))*
Post (if any post held: Manager/Director/DG/Member/Chairman etc.)
Name of Organization/University/Department of Work (Present/Last)*
Center/University Department/etc. of Work (Present/Last)*
Date of Retirement:*

YYYY
MM
DD
Length of Service/Years of Experience:*
Civil Awards
- Nishan-e-Imtiaz (NI)
- Hilal-e-Imtiaz (HI)
- Sitara-e-Imtiaz (SI)
- Pride of Performance (PoP)
- Tamgha-e-Imtiaz (TI)
- Other Award/Honor
Write names of other civil/national/international awards/honors
Memberships and Fellowships of other National and International Societies/Bodies
Description of Expertise*
Official Address:
Residential Address:*
Phone (Official/Residential)
Cell:*
Email:*
Please upload bank receipt image of membership fee Rs. 5000:
Please upload your recent photograph for Membership Card: