Application form for Corporate LIFE Membership of Indian Cryogenics Council
Application form for Corporate LIFE Membership of Indian Cryogenics Council
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Corporate Name in block letters *
Name of Head of Corporate Prefix (Dr. / Prof. / Mr. / Ms. / Mrs.) followed by First name, Middle name &  Surname *
Designation *
 Contact Mobile Number (Kindly keep ICC updated in case of any change) *
 Contact Landline Number (Kindly keep ICC updated in case of any change) *
Email id *
Business Type *
Website address *
Main Products *
Date of Establishment/Incorporation *
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Total Number of Employees *
Complete Address (Office) along with pin code, city, state, landline & fax numbers *
Complete address (Works) along with pin code, city, state, landline & fax *
Preferred address for communication *
Please mention details of another Person 1 from the Corporate: Name, Designation, Age, Email ID & Contact Number *
Please mention details of another Person 2 from the Corporate: Name, Designation, Age, Email ID & Contact Number *
Area(s) of specialization *
Required
Brief Description of Specialization (Please email the Company brochure on icc.iuac@gmail.com *
Please mention details of a reference (Person 1) from the field of Low-temperature physics / Cryogenics: Name, Designation, Affiliation, Email ID & Contact Number *
Please mention details of a reference (Person 2) from the field of Low-temperature physics / Cryogenics: Name, Designation, Affiliation, Email ID & Contact Number *
Bank Account Details for NEFT                                                                 * Account Name: Indian Cryogenics Council Delhi                                       * Account No: 10596550960                                              * IFSC Code: SBIN0001624                                                * Bank Name:  State Bank of India                                      * Branch Name & Address: Jawaharlal Nehru University, New Mehrauli Road, New Delhi-110067             * MICR No.: 110002056                                                      * Fees: INR 25000/-                             *
Preferred Mode of Payment for Registration                                                                                   *
Transaction ID of the payment made, Cheque / DD numbers, if applicable *
Date *
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Signature (Please write your complete name) *
Membership Decision (For use of ICC only, not to be filled by the applicants) : Your membership fees will be refunded in case the membership is unaccepted
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