Calcutta Statistical Association
UNIVERSITY COLLEGE OF SCIENCE
35,BALLYGUNGE CIRCULAR ROAD,CALCUTTA-700019
  Application form for Membership


 

  I am in sympathy with objects of the Calcutta Statistical Association and I am desirous of becoming a Member of the Association. I agree to abide by the Constitution and the Rules and Regulations of the Association.
  I am sending the sum of as my membership fee by Cheque/ Money Order/ Cash.


  Date:
    (Signature)       

  (Please fill up in block letters)
  Name in full (with titles and degrees)

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  Residential Address


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  Occupation and place of Employment


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  Other particulars


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  Email ID of Member
[ ***In case of online form submission User should supply a valid email ID otherwise form will not be accepted]
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  (For office use)


  Form received on: ______________ Subscription received on: ______________

  Proposed by
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  Seconded by
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  Date of Election
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  Membership No.
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    _____________________
    Signature of the Secretary