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ISA (D) Membership Enrollment Form

ISA membership form

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Abhishek
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11 views1 page

ISA (D) Membership Enrollment Form

ISA membership form

Uploaded by

Abhishek
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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ISA Delhi Section Membership Enrollment Form

Mail duly filled in form to ISA Delhi Section, Rewards for Recruiting Program:
33, DSIDC, CWC Kalkaji, New Delhi -110019 with ISA Sponsor Name …………………………………………….
Payment of Rs. 4000/- (UPI: isadelhi@ybl)
Tel.no. 9313384543 (PAYTM, PHONEPE or GOOGLEPAY) ISA Sponsor Membership ……………………………………..
Cheque/DD : “The Instrumentation Systems and Automation Society Delhi Section” A/c no. 06291131003341 (PNB ), IFSC: PUNB0062910

1. Member Information This Section must be completed in full.


 Mr.  Ms.  Dr.
Name Last/Family (Include suffix and /or professional designation) First/Given Middle

Company Position/Title

Business Address Information : This section must be completed to receive the FREE subscription to Motion Control magazine. (See section 4b.)

Street address/PO Box Mail Stop

City State/Province Postal Code

Country E-mail

Telephone include area code of country and city code Fax (include area code or country and city code)

Home Address Information :

Street address/PO Box Unit

City State/Province Postal Code

Country E-mail

Telephone (include area code of country and city code) Celular/Alernate Phone (include area code or country and city code)

Preferred Mailing Address (check one):  Business Home Preferred Billing Address (check one) : Business  Home
Birth date (month/day/year) Would you like information on senior Membership?  Yes No
Have you ever been a member of ISA?  Yes  No If yes, list last year of membership : ________________________________________

Highest degree earned :  High School  Associate/Vocational  Bachelors  Masters  Doctorate

STUDENTS ONLY : _________________________________________________________________________________________________________________


School Required : Date of graduation (mm/yyyy)

2. Job Information This section must be completed in full.


2A. Check your primary job function (choose only one) 2B. Check your Industry classification : (choose only one)

Manufacturing Industries Transportation and Public Utilities


 Control Systems Engineering (B)  Chemicals (2800)  Transportation – Aerospace (3760)
 Education (N)  Electronic & Other Electric Equipment (3600)  Transportation – Aircraft (3720)
 Engineering Consulting (AG)  Food (2000)  Transportation – Automotive (3710)
 Engineering Management (3)  Industrial Machinery & Equipment, Including Computers (3500)  Transportation (3700)
 Environmental Control’s (AI)  Instrumentation, Measurement, Analysis & Control Apparatus (3800)  Utilities (4900)
 General or Corporate Management (A)  Medical Instrumentation & Systems (3840)  Utilities – Electrical (4910)
 Marketing or Sales (C)  Petroleum Refining & Related Industries (2900)  Utilities – Natural Gas (4920)
 Measurement, Testing, Quality or Standards Engineering (I)  Pharmaceuticals (2830)  Utilities – Combination (Nuclear/Fossil Fuel, etc.) (4930)
 OEM Product/Systems Engineering (A2)  Primary Metals (3300)  Utilities – Pipelines except Natural Gas (4600)
 Plant Information Systems (G)  Pulp, Paper & Allied Products (2600)  Utilities – Water/Wastewater (4940)
 Product Design Engineering, Including applied R & D (1)  Rubber & Miscellaneous Plastics (3000) Engineering & Other Services

 Production Engineering (D)  Semiconductors & Electronic Components (3670)  Communications/Data Distribution (4810)
 Research & Development (J)  Stone, Clay, Glass and Concrete Products (3200)  Construction (1700)
 Safety, Systems Engineering (AJ)  Textiles (2200)  Education (8200)
 Software Engineering (F)  Tobacco Products (2100)  Engineering Services (8710)
 Systems Design Engineering (S)  Valves, Fittings, Fabricated Metal Products (3400)  Government (9100)
 Systems Integration (H) Mining  Instrument & Control Apparatus Sales & Service (5000)
 Technical or Engineering Support (K)  Metal Mining (1000)  Management Consulting (8740)
 Other (P) ___________________________________________  Oil and Gas Extraction (1300)  Research, Development & Testing (8730)

SIGNATURE : This application cannot be processed without your signature

Signature Date :

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