Você está na página 1de 2

Indian Institute of Scientific Heritage

Estate Road, Papanamcode, Trivandrum - 695 018, Keralam, India.


Ph: +971-471-2490149 / www.iish.org / www.iishglobal.org

Membership Application Form (online) 
No:-
:
Name

Permanent Address :

Email :

Res. Num / Mobile Num :

Company/Organization :

Job Title : 

Language of Interest :

Membership Category (Select one)


Patron Member (5000rs)
Advisory Council Member (1000rs)
Fellow Membership (500rs)
Please fill the Payment Details
Pay By
Cheque / DD
Transfer / Direct Remitting
Cash by Hand
Cheque / DD / Transfer /Ref Num /
:
Bank / branch details /

- Signature
NOTE :-
Send your fully filled form with payment / Payment details to :-
Hon. Director,
Indian Institute of Scientific Heritage,
'Ushus', Estate Road,
Papanamcode, Trivandrum - 695 018,
Keralam, India.
Ph: +971-471-2490149

You will receive the Membership card, Receipt and our publications soon after
becoming a member by post/courier.

Categories of membership :

• Patrons : INR 5000


• Advisory Council Member : INR 1000
• Fellow Member : INR 500
*INR - Indian Rupee

You can remit the amount as DD / Cheque or directly to the account number
at SBT Pappanamcode, Trivandrum AC No. 57020795171 of Indian Institute of
Scientific Heritage.

Account Details :
Beneficiary Name : Indian Institute of Scientific Heritage
Account Number : 57020795171
IFSC Code : SBTR0000030
MICR No : 695009035
Bank/Branch : SBT Pappanamcode, Trivandrum

You Can also send Your Cheque or DD to:

Hon. Director,
Indian Institute of Scientific Heritage,
'Ushus', Estate Road,
Papanamcode, Trivandrum - 695 018,
Keralam, India.
Ph: +971-471-2490149

Your Membership will be activated soon after receiving your payment.


And will be considered as Rejected in case of not receiving the payment with in
30days after submitting the Membership Application Form.

You can get a quick update on your membership at ph:- +91 471- 2490149