INTERNATIONAL COLLEGE OF CARDIOLOGY
Prof Dr Daniel Pella, MD, PhD, FICC/ Prof Dr Jan Fedacko,MD,PhD, FICC
Email. Daniel.pella@upjs.sk tel +421 905340945, www.iccsk.com .
ICC-Canada, Dr Mahmood Moshiri,MD,FICN,Email: moshiri@nextpharmainc.com
The Executive Director
International College of Cardiology
Name. Mr/Mrs/Dr/Prof------------------------------------------------Age Sex
Qualifications………………………………………………………………………….
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Tel Fax email--------------------------
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Proposer’s; Dr R B Singh or…..

I wish to be a Life member of the International College of Cardiology.I promise to follow the
Byelaws of this organization.
My life membership (Euro.300.00)+fellowship fee(Euro.50.00) total fee Euro..350.00 is
enclosed.(Nonrefundable)
Draft/Cheque No…………………..dated…………. (Fee is nonrefundable)
My corporate membership fee Euro.1000.00 Overseas
Company is enclosed. International members should send their fee to Dr Daniel Pella.
Signature.-----------------------------------Date……………………….
Decision of the Executive Director: Accepted/ Rejected. Accepted, Date…………..

Executive Director/Secretary General