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APPLICATION FOR MEMBERSHIP |
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Registered Office: 302,Srikant Chamber, Next to R.K. Studio, Sion Trombay Road, Chembur , Mumbai 400 071. Tel.: 25209069 Fax: 55986907 Email: confex@vsnl.com Admin Office: KET's Vaze College, Mithagar Road, Mulund , Mumbai 400 081. Tel.: 21631422, 21631423 Email: ketvaze@bom3.vsnl.net.in |
FOR OFFICE USE | |
| Membership No.
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Date of admission
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| Hon. Secretary |
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| DETAILS OF REMITTANCE | ||
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To,
Hon. Secretary, The Indian Society of Cosmetic Chemists(ISCC) Sir, I hereby apply for the membership of the Society as indicated herein and declare that on admission, I shall abide by the Rules and Regulations of the Association. I hereby enclose a cheque/DD of Rs. towards the membership fees. Date: Signature of Applicant Note: Forms duly filled in will only be considered for membership |
>Admission Fee Rs.
>Membership Fee Rs.
>Outstation Bank Rs.
Charges |
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| Total Rs. | ||
| Amount (in words)
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| Cheque /DD No.
Date Drawn on Bank Branch |
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Full Name (in Block Letters) Dr./ Mr./ Mrs./ Ms.
Surname First Middle |
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| Mailing Address
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Present Designation Office, Address & Email
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| Tel/Fax/Cell No.
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Date Of Birth
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| Type Of Membership (Tick any one) FELLOW LIFE AFFILIATE STUDENT | |
| Qualification(Highest Only)
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| Present area of Work(Tick any one)
Marketing
Manufacturer
QA/QC
Regulatory
R&D
Teacher
Other(Specify)
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Certified that Mr. /Miss _____________________________________________________ is bonafide student of this institute and is studying for________________year _________________ degree/diploma. SEAL OF INSTITUTE Signature of Principal |
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