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Proposed by ICBC Member (Name and Organization)

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________________________________________________________________________________________________________________________________________________

APPLICATION FOR STUDENT


MEMBERSHIP/RENEWALS
Delhi | Mumbai | Ahmedabad

I request you to kindly admit me as an Individual student member of the Indo-Canadian Business
Chamber I hereby agree that if admitted as a member I / we shall be bound by the memorandum,
rules and regulations of the Chamber: I agree to pay renewal fees as applicable or revised by the
Regional Council/ Chapter on an annual or on a two-yearly basis and I will cooperate with the ICBC
Regional Council/Chapter.

Yours truly, _______________________________________________________________________

TYPE OF MEMBERSHIP REQUIRED: □ Individual Student Membership


Name: _________________________________________________________

Address: ___________________________________________________________________________________

___________________________________________________________________________________________
Telephone, Fax nos. and e-mail ID:
___________________________________________________________________________________________

Name of the Institution:

Program:

Connection with or interest In Canada:


___________________________________________________________________________________

___________________________________________________________________________________________

Payment particulars

Cheque number_________________Date_______________Bank/Branch______________________________

MEMBERSHIP CHARGES: Two years Student


Membership 1000
fees

*This fee is valid until the student is in the


program.
Proposed by (Name and Organization)
___________________________________________________________________________________________

_________________________________________________________________________________________________________________________________________________

1am □ / am not □ able to assist in organizing events and seminars for the ICBC

1/ we would like the Chamber to have/organize/promote:

___________________________________________________________________________________________
INDO-CANADIAN BUSINESS CHAMBER

Tel: +91 11 4710 7316 Fax: +91 11 4710 7399 E-mail:


info@icbc.org.in