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New Member Registration Form
Membership Type:
*
:
Individual
Corporate(5 Members)
Corporate(10 Members)
( Please provide your profile with Passport size photo)
Upload Applicant Photo :
Note :
Member Photo Ideal Size :- Width:1200px, Height:1200px, Max Size :1MB
Note :
Click here to delete uploaded image.
Name of the Primary Applicant
*
:
-Select Title-
Mr.
Ms.
Dr.
Nationality
*
:
Passport No.
*
:
Birth Date
*
:
CPR No.
*
:
Position (Designation/Title):
Email
*
:
Mobile
*
:
First Name
Middle Name
Last Name
Mobile
Email
Member 2
Member 3
Member 4
Member 5
First Name
Middle Name
Last Name
Mobile
Email
Member 2
Member 3
Member 4
Member 5
Member 6
Member 7
Member 8
Member 9
Member 10
Note :
Please also provide the following details of your secretary:
Name of the Secretary:
Email Address:
Contact Number:
Name of the Company
*
:
Office
*
:
Building
*
:
Road
*
:
Block
*
:
Area
*
:
C.R. No
*
:
P.O. Box
*
:
Telephone:
Website:
Positions held in other Clubs/Institutions/Societies
*
:
Business connections with India
*
:
(Joint ventures, agencies, any other. If space is insufficient please attach a sheet)
I confirm that you may use my email Id, mobile number and profile for any purposes of the BIS including BIS Website/Service providers/online meetings/ Events. I undertake to maintain confidentiality of information from BIS.
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