CSA Membership Form

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Calcutta Statistical Association
UNIVERSITY COLLEGE OF SCIENCE
35,BALLYGUNGE CIRCULAR ROAD,CALCUTTA-700019
E-mail: csa@calcuttastatisticalassociation.org
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 Ordinary/Life membership fees by Cheque on Kolkata Bank or Cash.

Date: ______________ ___________________
(Signature)
(Please fill up in block letters)

Name in full (with titles and degrees)

:

Residential Address

:

Corresponding Address

:

Occupation and place of Employment

:

E-mail

:

Phone No

:

(Office)

(Residence)

Other particulars

:

(For office use)

Form received on: _____________________

Subscription received on: _______________________

Proposed by

:

Seconded by

:

Date of Election

:

Membership No.

:
_______________________________
(Signature of the Secretary)
 

(Inland Member)

(Foreign Member)
Ordinary Membership feesRs. 400/- US$ 40.00
Life Membership feesRs. 3000/- US$ 400.00
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