Nepalese Society of Spectroscopy and Microscopy (NSSM)
Membership Application Form

Personal Information

1. Full Name:
   (First Name, Middle Name, Last Name)

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2. Date of Birth:
   (DD/MM/YYYY)

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3. Gender:
   ☐ Male ☐ Female ☐ Other

4. Nationality:

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5. Address:

   • Permanent Address: __________________________________
   • Current Address: ____________________________________

6. Contact Information:

   • Phone Number: ______________________________________
   • Email Address: ______________________________________

7. Academic Qualification:
   (Include highest degree obtained and specialization)

   • Degree: _____________________________________________
   • Specialization: _______________________________________
   • Institution/University: ________________________________

8. Professional Information:

   • Current Designation: _________________________________
   • Organization/Institution: _____________________________
   • Work Experience: ___________________________________

Membership Details

9. Membership Type:
   (Select one based on eligibility)
   ☐ Life Member ☐ Regular Member ☐ Student Member ☐ Institutional Member

10. Area of Interest:
    (Check all that apply)
    ☐ Spectroscopy ☐ Microscopy ☐ Materials Science
    ☐ Other (Please Specify): _______________________________

11. Reason for Joining NSSM:
    (Briefly explain your motivation)

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Additional Information

12. Reference (if any):
    (Name and Contact of the referee, if applicable)

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13. Attachments Required:

    • Copy of Academic Certificates
    • Copy of Citizenship or Passport
    • Recent Passport Size Photograph
    • Payment Proof for Membership Fee

Declaration

I hereby declare that all the information provided is true and correct to the best of my knowledge. I agree to abide by the rules and regulations of the Nepalese Society of Spectroscopy and Microscopy (NSSM).

Signature: ________________________
Date: _____________________________

Payment Details

Membership Fee Payment:

• Account Name: Nepalese Society of Spectroscopy and Microscopy
• Bank Name: _________________________
• Account Number: _____________________

For Official Use Only

Membership Number: ______________________________
Membership Category: _____________________________
Date of Approval: _________________________________

Approved by:
Name: ____________________________
Signature: _________________________

Send to: info@nsosm.org.np, spectromicronepal@gmail.com