THE INDIAN STRUCTUAL INTEGRITY SOCIETY

c/o Fatigue and Structural Integrity Group

Structural Technologies Division
CSIR-National Aerospace Laboratories
Bengaluru 560017, India
instint.in

Phone:080-2508 6310 Fax:080-2508 6301 E-mail: insisblr@gmail.com

MEMBERSHIP REGISTRATION FORM

Name: Passport Size Photo

Date of Birth

Nationality

Professional Designation and

Address (official)

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Fax:
Mobile:
E-mail:
Address (Residential)

Tel:
Fax:
Mobile:
E-mail:
Academic Qualifications

Degree University Year of Passing Specialization Remarks

Professional Experience

From To Organization Designation Nature of Work

Type of Membership Applied for

Membership fee details: Cheque/ DD No, date, bank etc

Cheque/DD should be in favor of Indian

Structural Integrity Society and Payable at
Bengaluru e-transfer details

Details of Society account for E-transfer:

Bank: State Bank of India

Branch: NAL branch, Bengaluru-17
IFSC code: SBIN0004815
Type of account: Current account
Account no.: 34643078190
Referred by :
I, the undersigned, do hereby state that the statements made in this Application Form for the
Membership of the Society are correct. In the event of my selection, I will be governed by the
Rules of Society as they are now framed or as they may be altered hereafter amended or enlarged
under the powers of the said Rules. As member of the Society, I will advance the objectives of
the Society as far as feasible.

Date: Signature of the applicant

Place:

For Office Use Only

The Council, having considered the application and approved/differed consideration/not

approved the application.

Reference: Minutes of the Council Meeting held on ...

Date: Secretary