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Note for those who are applying for Studends & Academic Institutional Membership
2nd National Conference; INDIACom-2008
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Registration
I hereby apply for membership for the under mentioned grade
. On approval of membership i shall abide by the Constitution & Belaws of the socity and the code of Ethics
ASSOCIATE MEMBER:
Student
Individual
Individual Life
Nominee (Institution)
Life Membership Educational Iinstitutions
Life Membership Non Educational Iinstitutions
Nominee(Academic Institution)
Student/Individual Member
Kindly Enroll me for the Period
1 Year
2 Year
3 Year
4 Year
5 Year
6 Year
7 Year
8 Year
9 Year
10 Year
11 Year
12 Year
13 Year
14 Year
15 Year
17 Year
18 Year
19 Year
20 Year
Attach Proof of age for the life membership
Size: 10KB:
Student Bonofide Certificate for Student Membership
Size: 10KB:
1. Name Details
Title:
Mr.
Ms.
Mrs.
Dr.
Surname:
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First Name:
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Father Name:
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Address:
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City:
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State:
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Pin:
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Nationality:
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Indian
NRI
Phone No:
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With Std Code
Fax No:
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5.Email
Email:
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4.Date of Birth
Date:
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Month:
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Year:
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4.SEX
sex:
Male
Female
4.Qualification Details
Degree:
Post Graduation:
Doctoral:
Others:
4.Work Details
Sector of Work:
Year Of Experiance:
Region:
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Region-2
Region-3
Region-4
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Region-6
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Chapters:
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Ahmedabad
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Name of Branch for students Members Only:
Would you like your name to be excluded from the membership lists if given for commerial purpose? :
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eg. 00008252
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