LVA Life Membership Form

Events

6th Annual Conference Of Laryngology
and Voice Association

Date : September 22, 23, 24

Bengaluru, India

Visit : http://www.lvasummit2017.com/

The L.V.A. is a scientific society established to promote the concept and application of a Voice Clinic for the benefits of the general public.
Laryngology And Voice Association registration of society as per the societies Registration Act 1860 column 21
Registration No. : Maha 2354/2010/Pune


Name *	:

Age	:

Sex	:	Male Female

Qualification *	:

Institution	:

Department / Position	:

Address	:

City	:

Pin Code	:

Country	:

Phone (STD Code)	:

Mobile *	:

Email *	:

Years of Training or Practice.	:

Member of any Voice / Laryngology association	:

Participated in Voice / Laryngology seminars	:

List of Paper / Book Chapter published in Laryngolgy	:

List of current Laryngology research projects involved	:

Hobbies / extra curricular activities	:



Life membership fee : Rs.2000/- for ENT surgeons and Rs. 1500/- for Speech Language Pathologist and Allied specialty to be sent by Cash / Multicity Cheque / Demand Draft in favor of "Laryngology & Voice Association", payable at Pune.

The life membership includes:
Subscription for the 'Journal of Laryngology & Voice' a peer reviewed journal published every six monthly in online and in print format.

10% waiver of charges for the annual conference of LVA, for the VOICECON & AIRWAY course at Deenanath Mangeshkar Hospital, Pune and for any other course organized by LVA.

Members are eligible to apply for the 4 weeks International Fellowship by LVA.