ACOUSTICAL SOCIETY OF INDIA

(Regn. No. 65 of 1971, Visakhapatnam)

Individual Membership Application Form(Life Member)

Mr. PVS Ganesh Kumar
General Secretary
Acoustical Society of India
NSTL, Vigyan Nagar
Visakhapatnam-530 027
1.

Name and Designation ____________________________________________________

2.

Date of Birth

___________________________________________________________

3. Present Post and Scale of Pay ________________________________________________

4.

Details of academic qualifications ____________________________________________

5.

Field of Specialization ______________________________________________________

6.

Telephone No (O) __________________(R) __________________Fax. _______________

Mobile No.________________________

7.

E-mail ________________________________

Mailing Address __________________________________________________________

___________________________________________________________

8.
9.

Permanent Address ________________________________________________________

___________________________________________________________
Membership of other
Scientific organizations

___________________________________________________

10. Bank Draft /Cheque detail ___________________________________________________

Draft / cheque for Rs 2200/- should be drawn in favour of Acoustical Society of India payable
at Visakhapatnam (Rs. 50/- Bank Commission charges should be added for outstation cheques)
Life Membership fee: Rs. 2200/- (Including Admission fee of Rs 200/-, for Indian Nationals)
Life Membership fee: US$ 100/- or equivalent ( for Foreign Nationals)
DECLARATION BY APPLICANT
I certify that the information furnished above, is true to the best of my knowledge and belief. Also, upon my
election as member of Acoustical Society of India, I agree to abide by the rules and regulations of the Society.

Date:
Proposed by _________________________ Signature

Signature of the Applicant

Seconded by _________________________ Signature

FOR OFFICE USE
Payment received vide Cash/Bank Draft / Cheque ____________
Membership No. :
LM __________

(Gen Secretary / Treasurer)

ACOUSTICAL SOCIETY OF INDIA

(Regn. No. 65 of 1971, Visakhapatnam)

Individual Membership Application Form(Life Fellow)

Mr. PVS Ganesh Kumar
General Secretary
Acoustical Society of India
NSTL, Vigyan Nagar
Visakhapatnam-530 027
1. Name and Designation ____________________________________________________
2. Date of Birth

___________________________________________________________

3. Present Post and Scale of Pay ________________________________________________

4. Details of academic qualifications ____________________________________________
5. Field of Specialization & Duration of Experience in the field of Acoustics_____________
____________________________________________________________________________
6. Telephone No (O) __________________(R) __________________Fax. _______________
Mobile No.________________________

E-mail ________________________________

7. Mailing Address ___________________________________________________________

__________________________________________________________________________
8. Permanent Address ___________________________________________________________
__________________________________________________________________________
9.

Membership of other Scientific organizations _______________________________________

If already Member of Acoustical Society of India, Membership No: _______________________
10. Bank Draft /Cheque detail ___________________________________________________
Draft / cheque for Rs 2200/- should be drawn in favour of Acoustical Society of India payable
at Visakhapatnam (Rs. 50/- Bank Commission charges should be added for outstation cheques)
Life Fellow fee: Rs. 2200/- (Including Admission fee of Rs 200/-, for Indian Nationals)
Life Membership fee: US$ 100/- or equivalent ( for Foreign Nationals)
Above fee is Not Applicable for upgradation of existing Life Member to Life Fellow.
DECLARATION BY APPLICANT
I certify that the information furnished above, is true to the best of my knowledge and belief. Also, upon my
election as member of Acoustical Society of India, I agree to abide by the rules and regulations of the Society.

Date:
Proposed by _________________________ Signature

Signature of the Applicant

Seconded by _________________________ Signature

FOR OFFICE USE
Payment received vide Cash/Bank Draft / Cheque _______________
Membership No. :
LF __________

(Gen Secretary / Treasurer)

ACOUSTICAL SOCIETY OF INDIA

(Regn. No. 65 of 1971, Visakhapatnam)

Institutional Membership Application Form

Mr. PVS Ganesh Kumar
General Secretary
Acoustical Society of India
NSTL, Vigyan Nagar
Visakhapatnam-530 027
1.

Name of establishment/firm _________________________________________________

2.

Date of Establishment

_________________________________________________
3. Field of Specialization
___________________________________________
___________

4.

Organization (If applicable)____________________________________________________

5.

Name & Present Designation of person representing the establishment/firm

__________________________________________________________________________

6.

Telephone No. (O)_____________________(R) _________________Fax.______________

Mobile _______________________ E-mail

7.

____________________________

Mailing Address __________________________________________________________

___________________________________________________________

8.

Permanent Address ________________________________________________________

___________________________________________________________

9.

Membership of other
Scientific organizations

10.

Bank Draft /Cheque details ___________________________________________________

___________________________________________________

Draft / cheque should be drawn in favour of Acoustical Society of India payable at

Visakhapatnam (Rs. 50/- Bank Commission charges should be added for outstation cheques)
Life Membership fee: Rs. 25000/- (Institutional Member)
DECLARATION BY APPLICANT
I certify that the information furnished above, is true to the best of my knowledge and belief. Also, upon my
election as member of Acoustical Society of India, I agree to abide by the rules and regulations of the Society.

Date:
Proposed by _________________________ Signature
Seconded by _________________________ Signature
FOR OFFICE USE
Payment received vide Cash/Bank Draft / Cheque ____________
Membership No. :
IM __________

Signature of the Applicant

(Gen Secretary / Treasurer)