Indian Innovators Association

APPLICATION  FOR MEMBERSHIP OF

INDIAN INNOVATORS ASSOCIATION

 To:

Indian Innovators Association 
NCR region
C/O P.S.S. Prabakar Rao
A-50, Ashoka Enclave -II,SECTOR 37,FARIDABAD-121003 , INDIA 
Tel: +91 129, 4128748, Fax: + 91 11 2250086 (M) 9811144662
E-mail: IIA.IIIF2016@gmail.com,  indiainvents@hotmail.com
Online payment details: http://www.indiainvents.in/about.html

I would like to enrol as member of Indian Innovators Association. Details are given below:

Membership applied for :      Individual ( life) (Rs2,000)($50)
                                                Institution/ Organisation (Life)(Rs20,000)($500)

 Name:      
Address:   
                    
Brief particulars of     applicant                    
(attach CV)
Payment Details     Cheque/DD no------------------------- Name of Bank
                                    Amount    --------------------------------------------------------------------           
( if payment made online, give details)
Date :                                                                                                                        SIGNATURE