INDIAN SOCIETY FOR ADVANCEMENT OF MATERIALS AND …



|[pic] |INDIAN SOCIETY FOR ADVANCEMENT OF |

| |MATERIALS AND PROCESS ENGINEERING |

| |Aeronautical Society of India Building, Suranjan Das Road Junction, |

| |New Thippasandra, Bangalore 560 075 INDIA |

| |Website : |

APPLICATION FOR CORPORATE MEMBERSHIP

Name of the Company : …………….. ………………………………………………….

Date of Establishment :…………………………………………………………………..

Permanent Address :…………. …………………………………………………

….. ……………………………………………………………..

…………………………………………………………………….

Address for Correspondence :…………. ………………………………………………………

…………………………………………………………..

…………………………………………………………….

Telephone : Office:……………………E-mail:…………………………………….

: Mobile :…………………………….Website:……………………………

Annual Turnover / Budget :……………………………………………………………………

Nature of Activity : Manufacturing / R & D / Design / Testing /

Product Development / Others (Specify)

……………………….…………………………………………………………

Primary Materials & Processes used

(Attach sheet if necessary) ……………………………………………………………

Product Line :………………………………………………………….

Institution Category : Small / Medium / Large

(Please see information Brochure)

Whether applying for Life Membership : Yes No

Name and Designation of the : ……………………………………………………

Person representing the Company

at the meeting of ISAMPE …………………………………………………….

Name and Designation of the person :………………………………………………….

as an alternate to represent the Company

at the meetings of ISAMPE ………………………………………………….

Membership of other Professional Bodies:………… ……………………………………..………

.

Proposed by : Seconded by :

Signature…………………………………… Signature…………………………………………

Name………………………………………… Name……………………………………………..

Membership No……………………………. Membership No………………………………….

Declaration : The undersigned, on behalf of the company certifies that all the statements made herein are true and agrees to be governed by the Rules and Regulations of the Society.

Date :

Place : Signature of the Head of

the Company with the office seal

Cheque / D D No :………………………………… Amount:: Rs……………………………....

Date :……………………………….

Drawn on Bank :……………………………….

• Corporate Membership Subscription

| |2- Years |Life Membership |

| |Membership |(Valid for 30 Years) |

|Large Institutions |Rs. 30,000.00 |Rs. 3,00,000.00 |

|Medium Institutions |Rs. 20,000.00 |Rs. 2,00,000.00 |

|Small Institutions | Rs. 10,000.00 | Rs. 1000,000.00 |

(Membership Year : 1, April to 31, March)

• Cheque / DD should be made in favour of “ISAMPE, Bangalore” payable at Bangalore

• Please mail duly completed application form along with the remittance to the Secretary at ISAMPE office.

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