IAPQR, Indian Association for Productivity Quality & Reliability

INDIAN ASSOCIATION FOR PRODUCTIVITY, QUALITY & RELIABILITY
	( Affiliated to the International Statistical Institute ) Address: AD-276, Sector - I, Salt Lake City, Kolkata 700 064. Phone No.: 91-33-2334 6234/3 (12 Noon - 7 p.m.); Telefax: 91-33-2334 6234 Email: iapqr@yahoo.co.in

Application for Admission to Membership

I have gone through the rules and regulations of your society and being interested/ involved in the quality Movement in India, desire to be enrolled as an individual (anual/life)member of society. My particulars are given below. The required fee

Annual Member: Rs.250 per annum(India);US Dollars 15(Foreign)
Life Member : Rs.2,500 (India);US Dollars 150(Foreign)[one time]

is being sent in cash/M.O./byD.D.

1. Name:

2. Address:

a)Office

b)Residence

Telephone No.

a) Office: ______________

b) Residence:_____________

3. Occupation (with designation):

4. Qualification (with Specialisation):

Date: _________________
Place: _________________	_________________________________ Signature

Proposed By: Name: __________________	Dated Signature: __________
Seconded By: Name: __________________	Dated Signature: __________

For Office Use only

Application

i) received on _____________________________________

ii) placed before the Board of Governors on______________

MemberShip No. ________________

Membership intimated on _________

Institutional Membership Form

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