GERA membership form

1. GLOBAL EDUCATIONAL RESEARCH ASSOCIATION
(Registered Under Societies’ Registration Act 1860)
(Regn. No. 151 of 20111-12, Chandigarh)
H.O.: Global Educational Research Association, Centre for Education,
Central University of Punjab, Mansa Road, Bathinda, Punjab-151001 (India)
Website: www.thegera.in / e-mail: thegerahq@gmail.com
APPLICATION FOR INDIVIDUAL MEMBERSHIP
Life Membership: Rs. 2000/- (Indian) / USD 100 (Foreigner) Donor Member:_________
Mode of Payment: Cash /DD GERA Receipt/DD No.:_____________Date: __________
Bank (if DD): _____________________________________________________ Place: _______________
Name(in Block Letters): _____________________ _____________________ ______________________
Surname Middle Name First Name
Date of Birth: _________________________ Gender: Male / Female
Educational Qualification: _____________________________________________________
Designation: _________________________ Experience: _____________________________
Institution/Organization: ______________________________________________________
________________________________________________________ Pin Code: ______________
Residential Address: ___________________________________________________________
__________________________________________________________________________________
City: __________ State: __________ Country: __________ Pin/Zip Code: ___________
Contact Details.: ISD Code ____________ Mobile: _______________________________
Office (with STD code) : _________________ Resi. (with STD code): __________________
E-mail:____________________________________ Website: ___________________________
Declaration:
I hereby solemnly affirm that the information provided in this document is true to the
best of my knowledge.
Date:_____________
Place: ____________ Full Signature of Applicant
Draft to be drawn in favour of Global Educational Research Association payable at
Jalandhar.Application form along with membership fee Draft to be sent to President,
Global Educational Research Association, Centre for Education, Central University of
Punjab, Mansa Road, Bathinda, Punjab-151001 (India)
Date of Confirmation of Membership:_____________________ Membership No.: ______________________
Treasurer General Secretary