application form - Indian Statistical Institute

To
The Director
Indian Statistical Institute
203 B. T. Road
Kolkata – 700108.
Sir / Madam,
INDIAN STATISTICAL INSTITUTE
203 B. T. Road, Kolkata – 700108
I am in sympathy with the objects of the Indian Statistical Institute and I am desirous
of becoming an Ordinary Member of the Institute during the year . I
agree to abide by the Constitution, Regulations and Bye-Laws of the Institute, as may be
inforce from time to time.
I am sending the sum of *Indian Rupees/US$ ( )
only by Cash / Cheque (only Kolkata based) / DD (other than Kolkata) as my membership
subscription for the year . I am ordinarily resident in _____________ (Please
mention country as indicated (a), (b), or (c) or (d) in footnote).
Date
Signature in full
(Please fill up in Block letters)
Name in full Shri / Sm / Dr.
Academic and other distinctions
(Please attach xerox copies of relevant certificate)
Profession or Occupation with designations and particulars of Organisations / Institutions in
which employed :-
Present address
Phone (O)
Mobile
(R)
ISD STD ISD STD
E-mail ID
P.T.O.

- 2 -
Permanent address
Are you a Senior Citizen If yes, please state your date of birth
(Please attach xerox copy of evidence of age)
D D M M Y E A R
Please write briefly as to (a) why are you interested in becoming a member of the
Institute (b) how you expect to benefit by becoming a member of the Institute
and (c) specify the disciplines/topics/subjects in which you are particularly interested.
Proposed by Membership No. L/
( Signature ) O/
(As applicable)
Seconded by Membership No. L/
( Signature ) O/
(As applicable)
*Rates of Annual Membership subscription for Ordinary Members : (a) Members resident in
India - Rs. 500.00 (b) Senior Citizen members resident in India (above 60 yrs.) - Rs. 250.00
(c) resident in USA, Canada, Mexico, South America, Europe, Japan, Australia, New Zealand &
China - US$ 90.00 (d) Members residents in any other country excepting those in ‘C’ - Rs.
750.00.
+An Institute member is eligible to receive free copies of one series of Sankhya on receipt of a
written request from the member. The member should indicate which series he / she is interested
in receiving.
Filled in form alongwith the requisite amount will be received on and from 11.00 a.m. to 2.00 p.m.
Email : council@isical.ac.in Phone No. – (033) 2575 2255 Website : http://www.isical.ac.in