Nepal Pharma Association Membership Form

Personal Information

Name

Nationality

Sex

Male

Female

Others

Dob

Marital Status

Married

Unmarried

Academic Information

Academic Qualification

Offered By

Qualification On

Research Work

Working Institution

Permanent Address

Perm Zone

Perm District

Perm Mun Vdc

Perm Ward No

Perm Block No

Perm Telephone

Temporary Address

Temp Zone

Temp District

Temp Mun Vdc

Temp Ward No

Temp Block No

Temp Telephone

Name of two NPA members proposing for membership

#Member 1

Membership Type

Member Name

Membership No

#Member 2

Membership Type

Member Name

Membership No

Council Number

Either Council Number or Council Certificate must be provided

Please upload National ID,Certifcate File,Counsil Certifcate & others. Allowed File Extension : jpg,gif,png,doc,docx,pdf