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Laryngology & Voice Association
 (Reg No MAHA 2354/2010/Pune)
Head Office: Deenanath Mangeshkar Hospital & Research Centre
Erandwane, Pune-411004, INDIA.
TEL.+91 020 6602 3511 Email : voiceclinic@gmail.com
http://www.laryngologyandvoice.org ; www.journalonweb.com/jlv

Membership Form ( Membership of the institute is by application / invitation only )
Name :
Age :
Sex :
Qualification :
Institution :
Department / Position :
Address :
City :
Pin code :
Country :
Phone: ( Landline / mobile ) :
Email :
Years of Training or Practice :
Member of any Voice / Laryngology association :
Participated in Voice / Laryngology seminars :
List of Paper / Book Chapter published in Laryngolgy :
List of current Laryngology research projects involved :
Hobbies / extra curricular activities :

LVA Membership

Life membership fee : Rs.1000/- for ENT surgeons and Rs. 750/- for Speech Language Pathologist and Allied specialty to be sent by Cash / Multicity Cheque / Demand Draft in favour of “ Laryngology & Voice Association ”, payble at Pune.

The life membership includes:

• Subscription for the ‘Journal of Laryngology & Voice’ a peer reviewed journal published every six monthly in online and in print format.

• 10 % waiver of charges for the annual conference of LVA, for the VOICECON & AIRWAY course at Deenanath Mangeshkar Hospital, Pune and for any other course organized by LVA.

• Members are eligible to apply for the 4 weeks International Fellowship by LVA.
DEENANATH MANGESHKAR HOSPITAL & RESEARCH CENTER