8/14/2019 CSI Institutional Membership
1/2
Form 1
Educatin Directrate, Natinal Headquarters,
CIT Campus, IV Crss Rad, Taramani, Chennai - 600 113. Phone :
044-2254 02 Email : [email protected]
Website:http//www.csi-india.org
Appiain f Aadmi Iniuin Mmbhip
Yu can jin CSI nline http:// www.csi-india-rg oRcmplete this
applicatin frm and send with payment by pst / curier t CSI,
Chennai
TThe Director (Education)
Computer Society of India
Education Directorate, National Headquarters,
CIT Campus, IV Cross Road, Taramani,
Chennai - 600 3.
W hby appy f aadmi Iniuin mmbhip. on apprval f Membership, we
shall abide by the
Cnstitutin & Byelaws f the Sciety and the Cde f Ethics.
1. Name of the Institution (block letters)
2. Pstal Address (Block letters) :
(at which mail / ther crrespndence will be sent)
CITY
STATE
Phn wih stD cd
3. Email:
_____________________________________________________
4. Major Activity of the Institution :
5. Details of Nominating Authority :
Name Designatin
6. Names of the Nominees (3 nominees are allowed free)
Name of the Nominee Membership No. (for CSI use)
1.
2.
3.
Membership year April-March
For ofce use only
Membership N.
Receipt N.
Receipt Date
Mmbhip F f Aadmi Iniuin :
a) Entrance fee : Rs.1500/-Yay / rnwa f : Rs.3000/-
b) The academic institutin can nminate three nminees
asmembers.
c) Fr additinal nminee, yearly fee is Rs.900/-
d) Fr the membership enrllment during any quarter f the year
the fees payable are :
Pid f
Jining
enan
F
r.
F f
cun Ya
r.
F f
Nx Ya
r.
ta
r.
1st Quarter
(July t Sept)1500 3000 Nil 4500
2nd Quarter
(oct t Dec)1500 2250 3000 6750
3rd Quarter
(Jan t Mar)1500 1500 3000 6000
4th Quarter
(Apr t June)1500 750 3000 5250
e) Lng term membership
Fee Rs. 20,000/- fr 7 years (3 nminees are allwed free)Fee Rs.
55,000/- fr 20 years (3 nminees are allwed free)
enan f waivd f ng m mmbhip.
8/14/2019 CSI Institutional Membership
2/22
Form 1
7. Subscriptin / Payment Details (Tick ne as applicable)
Entrance Fee Rs. + Subscriptin Rs. = Ttal - Rs.
+ =
ti n a appia
DD N. Dad D D M M Y Y f r. ban ___________
Dpi f r. ____________________ a Axi ban sb A/ N. 082010100395144
banh ___________________
Paid hugh csI nin paymn gaway, wih tanain ID:
____________________
Paid hugh cdi ad: ____________________
8. Enter a chapter f chice frm the list belw :
rgin N. chap N.
Select yur chapter and Regin frm the List
rgin-I rgin-II rgin-III rgin-IV rgin-V rgin-VI rgin-VII
1. Allahabad 11. Durgapur 16. Ahmedabad 28. Balasore 37.
Bangalore 45. Aurangabad 54. Calicut
2. Chandigarh 12. Guwahati 17. Bhopal 29. Bokaro 38. Hyderabad
46. Goa 55. Chennai
3. Dehradun 13. Kolkata 18. Chittorgarh 30. Cuttack 39. Mysore
47. Mumbai 56. Cochin
4. Delhi 14. Patna 19. Gwalior 31. Dhanbad 40. New Guntur 48.
Nagpur 57. Coimbatore
5. Gaziabad 15. Siliguri 20. Indore 32. Raipur 41. Ongole 49.
Nashik 58. Hosur
6. Haridwar 21. Jabalpur 33. Rourkela 42. Vijayawada 50. Navi
Mumbai 59. Karaikudi
7. Kanpur 22. Jaipur 34. Ranchi 43. Visakhapatnam 51. Pune 60.
Pondicherry
8. Lucknow 23. Mhow 35. Jamshedpur 44. Koneru 52. Solapur 61.
Salem
9. Mankapur 24. Surat 36. Bhilai 53. Thane 62. Thanjavur
10. Noida 25. Udaipur 63. Trichy
26. Vadodara 64. Trivandrum
27. Vallabh 65. Vellore
Vidyanagar 66. Annamalainagar
9. Would you like your name to be excluded from the membership
lists if given for commercial purpose ? Yes No
10. cd f ehi : Undaing :
We afrm that as a CSI member, we shall abide by the Code of
Ethics of the Computer Society of India (CSI). We further undertake
that
we shall uphold the fair name of the Computer Society of India
by maintaninig high standards of integrity and professionalism. We
were not a
member of CSI earlier.
We are aware that our breach of the Code of Ethics may lead to
disciplinary action against us under the Byelaws and rules of the
CSI.
We hereby conrm that we shall be bound by any decision taken by
the CSI in such matters.
Place : Date : Signature :
CSIThe Only association in India that caters
directly to IT professionals and users
Together, we can help quicken the pace ofdevelopment in this
great country
