|
Membership Application for |
| Type of membership applied for |
|
| Upgradation from |
to
|
|
Provide Member Information |
| First Name |
|
| Last
Name |
|
| Gender |
|
| Date Of Birth |
|
| Company Name |
|
| Company Address
(Office) |
|
| City |
|
| State |
|
| Pin Code |
|
| Telephone with
STD Code |
|
| Mobile |
|
| Fax |
|
| E-mail |
|
|
Home Address Details |
|
Home Address |
|
| Pin Code |
|
| Telephone with
STD Code |
|
| Fax |
|
|
Preferred Mailing Address |
| Preferred Mailing Address |
Home
Office |
|
Educational Record |
| Course |
|
| Name of Institute/University |
|
| Location (City/Town) |
|
| Period
(From) |
|
| Period
(To) |
|
|
Employment Record |
| Period (From) |
|
| Period (To) |
|
| Name of Organisation |
|
| Address
of Organisation |
|
| Designation |
|
| Specific
Duties |
|
|
Technical Areas of Interest |
| First
|
|
| Other |
|
| Second
|
|
| Other |
|
| Third
|
|
| Other |
|
|
Principal Activity Of Your Company |
|
|
| Other
|
|
Papers Submitted |
| |
Yes
No
|
| Subject |
|
| Description |
|
| Reference
(Preferably ISHRAE member) |
 |
|
Certification By Applicant |
| The Undersigned
certifies that all statements are correct and agrees,If elected
by the Society, that He/She will be governed by its Bylaws and
Rules of the Board as long as association continues and, further
,aggress to promote objectives of the Societiy as far as shall
be in his / her power. |
|
Membership fees |
| Registration Fee |
Rs. 500/- (One Time) |
| Annual Fee |
Rs. 500/- |
* 1
st year Rs. 1000/-
* 2 nd to 5 th year Rs. 500/- per year. |
|
Payment details |
| Acccount Payee
Cheque (Outstation drafts only) to be drawn in favour of
" ISHRAE PUNE CHAPTER " |
| Date of Applicaton |
|
|
|
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