================================================================================ GERC MEMBERSHIP APPLICATION FORM Global Educational Research Council ================================================================================ APPLICANT INFORMATION: ================================================================================ Full Name: ___________________________________________________________________ Email: _______________________________________________________________________ Phone: _______________________________________________________________________ Organization/Institution: ____________________________________________________ Position/Designation: ________________________________________________________ MEMBERSHIP TYPE (Select One): ================================================================================ [ ] Professional Wing Annual: ₹5,000 OR Life: ₹25,000 [ ] Students Wing Annual: ₹2,000 OR Life: ₹10,000 [ ] Institutional Annual: ₹15,000 OR Life: ₹75,000 EDUCATION & QUALIFICATIONS: ================================================================================ Highest Qualification: ________________________________________________________ Field of Study: ______________________________________________________________ University/Institution: _______________________________________________________ Year of Completion: __________________________________________________________ PROFESSIONAL EXPERIENCE: ================================================================================ Years of Experience: __________________________________________________________ Areas of Expertise: ___________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ RESEARCH INTERESTS: ================================================================================ Primary Research Area: ________________________________________________________ Research Experience: _________________________________________________________ ____________________________________________________________________________ MOTIVATION FOR JOINING GERC: ================================================================================ Why would you like to join GERC? (Please explain in 100-150 words) ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ DECLARATION: ================================================================================ I certify that the information provided in this form is true and accurate. I understand and agree to abide by the rules and regulations of GERC. Signature: ___________________________ Date: _____________________________ PAYMENT INFORMATION: ================================================================================ Membership Type Selected: _____________________________________________________ Amount to be Paid: ____________________________________________________________ Payment Method: [ ] Bank Transfer [ ] Online Payment Portal [ ] Cheque/DD Bank Details (if applicable): Bank Name: ___________________________________________________________________ Account Name: ________________________________________________________________ Account Number: ______________________________________________________________ IFSC Code: ___________________________________________________________________ FOR OFFICIAL USE ONLY: ================================================================================ Application Received Date: ____________________________________________________ Verification Status: [ ] Pending [ ] Approved [ ] Rejected Approved Date: ________________________________________________________________ Membership ID: ________________________________________________________________ Remarks: ______________________________________________________________________ ____________________________________________________________________________ Processed By: _________________________ Date: _____________________________ GERC Administrator Signature: _________________________________________________ ================================================================================ Please send the completed form along with required documents to: Email: info@gerc.org Phone: +91 8248 213 812 ================================================================================