NAME                                    :……………………………………………

AGE                                        :……………………………………………

SEX                                         :……………………………………………

QUALIFICATION                 :……………………………………………

CURRENT PROFESSIOINAL AFFILIATION & ADDRESS (with Telephone numbers)

RESIDENTIAL ADDRESS (With telephone numbers, E-mail address)

CATEGORY OF MEMBERSHIHP APPLIED FOR :(Tick one of the following, below)

Life full member 
Student member

Proposed By:   Name:……………………………………Signature………………………….

Seconded By:   Name…………………………………….Signature……………………………

                                                             DECLARATION

I hereby declare that I agree to abide by the rules and regulations of DELHI PSYCHIATRIC SOCIETY

Name:………………………………                                   Signature………………………

Date………………………………..  

• You can take a print of application form from here and may apply for membership.
• For rules and regulation, please go to rules and regulations of DPS.

         Current membership fee are as follows,

•  Mental Health Professionals/Non-mental Health Professionals: Life member. Rs.5000/-
•  Student members- Rs. 3000/- but with the ID proof from the Head of the department or academic university     and after completing your tenure can upgrade to Life member.
•  Spouse could be member with same fee as Husband or Wife.
•  Send your application form along with requisite fee (by Local cheques, Draft or by cash) to

General Secretary:
Dr. Deepak Gupta
Centre for Child & Adolescent Wellbeing (CCAW)
R-92, Greater Kailash-I, NEW DELHI-110048 (Tel: 41733340 Mobile: 9810046115)
For any further query please do not hesitate to call General Secretary.

                                        ***************************************