Application Form for IPPTA Membership

(FOR TECHNICAL PERSON ONLY)

INDIAN PULP AND PAPER TECHNICAL ASSOCIATION

C.P.P.R.I. Campus, Paper Mill Road, Near Himmat Nagar
P. O. Box 47, Saharanpur - 247 001 (INDIA)
Tel: 0132 – 2714025, 2714082 Telefax: 0132 – 2714081
Email: ipptaonline@ipptaonline.org   Website: www.ipptaonline.org

 

Name in Full (in Block Letters) ……………………………………………………………………………………
Designation …………………………………………………………………………………………………………
Name of Organization ………..………………………………………………………………………………………
Mailing Address ……………………………………………………………………………………………………
………………………………………………………………………………………………………………………

Tel.:                                    Fax:                                  Email:                                           Mobile:

Date of Birth …………………………………………………………………………………………………………
Educational qualifications ……………………………………………………………………………………………
Brief Bio-data ………………………………………………………………………………………………………


………………………………………………………………………………………………………………………

Category of Membership desired


(Please mark in appropriate box)
            Corporate (      )                                 Member  (      )                                  Affiliate (      )
            Associate (      )                                  Overseas (      )                                  Student (      )
            Life          (      )

*Signature of sponsor with name and address:                                            Signature of the Applicant
                                                                                                                        Date……………. ……….

*If difficult to find sponsor, please get it sponsored by your Employer.

Payment to be made by Demand Draft in favour of  “Indian Pulp & Paper Technical Association” payable on any Bank, at Saharanpur and to be sent to Executive Secretary, IPPTA

For office use only

Application received on …………………………… Membership accepted / rejected ……………………………
Membership number …………….………………… Decision communicated on …………………………………
             

Executive Secretary