Individual Membership Membership Application Form Select Your Category (required) INDIVIDUALLIFE MEMEBRSENIOR CITIZENSTUDENT Name (In Capital Letters) (required) Father's / Husband's Name (required) Home Address (required) Pin Code (required) Date Of Birth (required) Age (required) Sex (required) MaleFemale Academic / Professional Qualification (required) Organisation : Name & Address (required) Organisation Phone (required) Organisation Mobile (required) Organisation Mail (required) Preferred Mailing Address (required) HomeOffice Your Current Designation (required) Date Of Appoinment (required) Experience as Supervisor or Executive cadre as on date(No. of Years) (required) Past Experience (Required) From To Designation Organisation and Job Details Any Papers Published / Presented (Optional) Title Publication / Occassion Date Remarks Membership of other bodies if any (Optional) Institution Category Professional Remarks Social / Service Category Remarks Any other Information (Optional) I / we agree to abide by the Memorandum of Rules of The Coimabtore Productivity Council. Introduced By Name Membership Certificate Number [group group-individual] Choose your Membership Fee (required) An entrance fee of ₹100 (with GST 18%) has been added along with the membership fee which you are going to choose below. ₹472 (with GST 18%) for Annual Subscription₹2596 (with GST 18%) for 10 Years long term special membership fee (with payment of / times annual fee)₹7198 (with GST 18%) for Life time Membership fee (with payment of 20 times annual fee) [/group] [group group-individual-senior-citizen] Choose your Membership Fee (required) An entrance fee of ₹100 (with GST 18%) has been added along with the membership fee which you are going to choose below. ₹354 (with GST 18%) for Annual Subscription₹2478 (with GST 18%) for Life time Membership fee (with payment of 20 times annual fee) [/group] [group group-individual-student] Choose your Membership Fee (required) ₹236 (with GST 18%) for Annual Subscription [/group] [group group-note-and-bank-details] Note: All cheques are to be drawn in favour of "The Coimbatore Productivity Council" The Year for membership is from April to March Members joining after September of any year need to pay only half the rate of Annual Subscription and full entrance fees except Students GST 18% Applicable Bank Details Bank Name : Kotak Mahindra Bank Bank Address : 727, Avinashi Road, Coimbatore, 641 018 Account Number : 04910010011454 IFSC Code : KKBK0000491 Pan No. : AAATT1411E GST No. : 33AAATT1411E1Z6 [/group] [group group-payment-details] Please enter Your Payment Details Below: Received From Mr. / Ms. (required) Total Amount (in Rs.) (required) Payment mode (required) ChequeDDNEFT [group group-payment-mode-number] Cheque / DD Number (required) [/group] [/group] Member Register