Ethnobotanical Society of Nepal (ESON)

ETHNOBOTANICAL SOCIETY OF NEPAL (ESON)
(Membership Form)

Name (Dr/Mr/Ms.):

Profession:

Position:

Nationality:

Address (Home):

Phone:

E-mail:

Address (Office):

Phone:

E-mail:

Academic Qualification (Last two degree only):

Name of Degree	Subject	Institution	Year

Field of specialization:

Area(s) of interest:

No. of research publication (s):

Publications related to Ethnobotany (If any):

1.
2.
3.

Type of membership (Please tick one of the followings):

Honorary Life Ordinary Associate
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Corporate (foreigner only):
Student/Researcher Professional

If my application for ESON membership is approved as a bonafide member of the Society, I hereby agree to abide by the constitution, rules and regulations of the Society.

Note: Please send the membership fee in favour of "Ethnobotanical Society of Nepal" by draft cheque to the bank, Saving account No.77190 , Nepal Bank Ltd. Central office, New Road, Kathmandu, Nepal. Your membership will be validated only after receiving the membership fee.

Date:

***Please print, fill up the form and submit to ESON office.