Notice Notice  
     
   
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ILTA Membership Registration Application Form

   
   
  Father's Name:  
  Date of Birth:  
  Blood Group:  
   
   
   
 
Permanent Address: Present Address:
Office Phone No: Residence Phone no:
Mobile Phone No: Email Address:
**Educational Qualification:   **Professional Experience:
 
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4.

   
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3.

4.
**Extra curricula activities:   **Specialisation in the field of:
  1.

2.

3.

4.
   
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2.

3.

4.
  Are you a Member of Executive Committee of ILTA ?  
    Yes  
  If Yes, Please Select your Designation  
   
  Want to Attach any Document Files ?  
  Verification Code:    
     
 


   
 
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