Umm Al-Qura University

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Request Form to Participate as a Member of the Saudi Scientific Society for Toxicology

Registration of a Member of the Scientific Society

     From : - 2021/08/22 م , To : - 2050/12/25 م
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User Details :

Following Data will be included with the From

    Request for Membership

     Please sign in via the National Single Sign-On, if you are not affiliated with Umm Al-Qura University.
    * His Excellency the Chairman of the Saudi Scientific Society for Toxicology

    I would like to inform you of my wish to join the society as a member

    * I wish that the type of membership to be:

    (He is entitled to attend the general assembly, vote, and be nominated for the membership of the Board of Directors.)

     * Active member (who is entitled to attend the general assembly, vote, and be nominated for the membership of the Board of Directors)
     * Affiliated member (university students and staff, and those interested in the society’s scope of work who can attend the general assembly without voting or nomination)
    * Entitlement to attend the general assembly, vote, and be nominated for the membership of the Board of Directors

    (He is entitled to attend the general assembly, vote, and be nominated for the membership of the Board of Directors.)

    * Personal Data

    Full Name

    * Identity

    National ID/ Residence/ Passport Number

    * Gender

    Personal Data

    * Academic Qualification

    Academic Qualification

     Workplace

    (If any)

    * Major
     Major

    Attach a document proving that your major is related to the society’s scope of work.

    Allowed extensions : mp3, wav, wma, mp4, wmv, avi, flv, gif, jpg, jpeg, png, 7z, csv, doc, docx, gz, gzip, pdf, ppt, pptx, ppsx, txt, xls, xlsx, zip
    Allowed Size : 1024
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     Please note that I have paid the membership fees.
     Deposited to the society’s bank account

    Bank

    * Proof of Payment

    Please attach a copy of the bank receipt.

    Allowed extensions : mp3, wav, wma, mp4, wmv, avi, flv, gif, jpg, jpeg, png, 7z, csv, doc, docx, gz, gzip, pdf, ppt, pptx, ppsx, txt, xls, xlsx, zip
    Allowed Size : 1024
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    * Country

    Please select a country

     City

    If your city is not stated above, please mention it.
    * Address

    City

    * Email

    @

    * 0560000000

    Mobile Number

      * Pledge (I hereby pledge that the information stated above is correct, and that I bear responsibility for it.)

    Pledge (I hereby pledge that the information stated above is correct, and that I bear responsibility for it.)

    I hereby pledge that the information stated above is correct, and I bear responsibility for it.


     
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