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Calcutta Statistical Association
UNIVERSITY
COLLEGE OF SCIENCE
35,BALLYGUNGE CIRCULAR ROAD,CALCUTTA-700019
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Application form for Membership
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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.
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Date: ______________
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___________________
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(Signature)
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(Please fill up in block letters)
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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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Form received on: ______________
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Subscription received on: ______________
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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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_____________________
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Signature of the Secretary
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