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IST Classification of Poisons
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Indian Society of Toxicology
Membership Application Form
Please fill all required details carefully
Date
Full Name (IN BLOCK LETTERS)
Date of Birth
Designation
Qualifications (with name of University, date of passing):
Official Phone
Official Email
Official Address
Permanent Address
Membership Type
Select
Life Membership (₹6000)
Life Membership – PG Student (₹4000)
Upload PG Status Letter (Official)
Payment Mode
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Demand Draft
Online Transfer
Bank Details for Online Fee Payment
Account Name
Indian Society of Toxicology
Bank
Dhanlaxmi Bank
Branch
Edapally
Account Number
015505300000384
IFSC Code
DLXB0000155
Account Type
Current
Transaction / DD No
Bank Name
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Signature
All information provided will be kept confidential and used only for IST membership purposes.
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