Welcome to ISHA

APPLICATION FOR STUDENT MEMBERSHIP

Note:

•	Please ensure you have filled in all details in the application form.
•	A filled in form will be sent to your email. Take a printout of the document, and send the copy along with DD/payment details to address mentioned in contactus page
•	If you are applying for Student member send letter of recommendation from your head of the department or institute.
•	YOUR APPLICATION WILL BE PROCESSED ONLY AFTER THE RECEIPT OF DOCUMENTS, PAYMENT AND VERIFICATION.
•	All fields highlighted are compulsory.

Personal Information:

Date:

Name:
		Firstname	Lastname	Surname

Date of Birth:(DD/MM/YYYY) Age: Gender:Male Female

Mailing Address:

City: State:

Country: Pin Code:

Phone No: Mobile: E-mail:

Same as Mailing Address

Permanent Address:

City: State: Country: Pin Code:

Phone No: Mobile: E-mail:

Upload Photo:

Choose a Passport size photo:

Educational Qualification:

Course Enrolled	Year of Admission	Name of the Institute (Please enter only the institutes name)	Upload ID Card
BASLP

Upload RCI recognition of your Institute for the period of study (JPG format):

Choose the document to upload:

Payment Details:

DD Number: Date: Payable at:

Membership Term : Amount:

Online/cash deposit @ BoB details only:

I have read the byelaws of the association. I hereby promise to abide by the byelaws of the Association.

Place:	Signature:
Date:	(typing your name here is your signature)