CRITICAL CARE NURSES SOCIETY

GUIDELINES TO START THE CHAPTER AND THE REGISTRATION

DETAILS FOR LIFE MEMBERSHIP
REGISTRATION DETAILS :
Membership fees : Life Member - Rs. 2000 + GST ( Rs 360/- i.e 2360/- as per new rules)

Renewal of old membership – Rs. 500/- (Life Member

Membership fees to be paid by Demand Draft in favour of “Critical Care Nurses Society” payable at
Mumbai. and kindly send to Head quarters
Prof Dr Jaya Kuruvilla, President Critical care nurses society
Emerald Court, D wing, Kondivita Lane , Marol pipe Line Andheri(E) Mumbai 400059 ; Email :
criticarensg.ccns@gmail.com
For correspondence contact :
Office Contact nos: 022 24232348
Ms Dakshata Nijai Treasurer 9975237397

FOLLOWING IS THE CRITERIA TO START THE CHAPTER :-

Enroll 15 Life members and send the required amount of Rs.2000 + GST ( Rs 360/- i.e 2360/- as per
new rules) along with application form to Head quarters

After receiving the Life membership card you may form the chapter.

For formation please do elect the following members :-

1) Chairperson

2)Secretary

3) Treasurer

4) Program Chairperson

 After election and conducting inaugural function. Send us the photograph, brief report and names of
office bearers . The same will be uploaded in the CCNS website.

 Can conduct programs at chapter level and send the report, will be uploaded in the website

 Can encourage for more Life members at chapter level.

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 CRITICAL CARE NURSES SOCIETY
Registration No 2968 dated 21.12.2011
Membership Form
Name of the candidate : ____________________________________________

Age : _________________ Date of Birth ______________________ Gender______________

Contact No : Residence _________________Mobile ________________

Email : _____________________________________________________________

Permanent mailing address : ____________________________________________

_____________________________________________________________________

State Nursing council Registration No ( Optional )_______________________

Professional qualification ________________________________________

Designation ________________________ Department ________________

Years of experience : _____________________________________________

Name and address of the institute _____________________________________

Signature of the candidate : ________________________

Kindly note :
Membership fees : Life Member - Rs. 2000 + GST ( Rs 360/- i.e 2360/- as per new rules)

Renewal of old membership – Rs. 500/- (LM)

Kindly quote the Existing membership No ________________ (if available)
Membership fees to be paid by Demand Draft in favour of “Critical Care Nurses Society”
payable at Mumbai.
For correspondence contact : Prof . Dr Jaya Kuruvilla President 9820926966
Ms Dakshata Nijai Treasurer 9975237397
Head quarters : Prof Dr Jaya Kuruvilla, Emerald Court, D wing, Kondivita Lane , Marol pipe
Line Andheri(E) Mumbai 400059 ; Email : criticarensg.ccns@gmail.com

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