Please enclose a passport size photograph of yourself. Also mention any personal achievements that you feel are important.
1. Name in capital letters : 2. Date of Birth : 3. Degree Year & Month of Passing University a. B.E. b. M.E. / MS. / Ph.D. c. Memberships 4. Present Position and Organisation 5. Address for correspondence Permanent Address Pin: Phone: Pin: Phone: (Any change in address may please be intimated) 6. Membership applied a) Donor Member Rs. 2000/- b) Life Member Rs. 200/-
Place: Date : Signature of the Applicant
Receipt No. Date: Membership accepted in the meeting held on Membership No. Signature of President