Individual / Life Membership Registration
Application Form for Individual / Life Membership
I, hereby, apply for new membership. On approval of Membership, I shall abide by the Constitution & Byelaws of the Society and the Code of Ethics.
Please also attach / upload a good quality minimum 300 x 300 pixels / passport size photograph along with a copy of Voter ID / Aadhar Card / PAN Card / Driving Licence to be used for making your CSI Membership Card.
Membership Type :* Membership Date :* Membership Period :*
PERSONAL INFORMATION
Title : * First Name :* Middle Name : Last Name :
Name you would like to be printed on CSI ID card :*
Date Of Birth : * Gender :
Primary Email ID :* Secondary Email ID :
STD/ISD Code : Phone : Mobile(Domestic membership) :*
MAILING ADDRESS (BLOCK LETTERS)
Address line 1 :* Country :
Address line 2 : State :*
Address line 3 : City :*
Pin Code :*  
Region :* Name of the Chapter to be attached :*
QUALIFICATION DETAILS
Highest Academic Qualification :* Year of Passing :*
University/Institute :    
PAYMENT DETAILS
Mode Of Payment *
Payment made through Online Payment Gateway :
For (Rs/-)*
Payment made through Demand Draft DD / Cheque payable at par at Mumbai should be drawn in favour of “Computer Society of India”.
      (Please Tick as applicable)
Amount Paid (RS/-) :*
Cheque / DD No. :* Dated :*
Drawn on Bank Name :* Branch Name :*
Fill following details if it is direct deposit in Axis Bank SB A/c. No.: 060010100082439
Date Of Deposit :*
Mode Of Deposit :*     (Please Tick as applicable)
Axis Deposite branch name :*
Attach photocopy of Pay-in-slip with application form and write your Name, Contact no. , Membership period on the reverse of the Cheque / DD / Pay-in- Slip.      
Code of Ethics - Undertaking :
I affirm that as a CSI member, I shall abide by the Code of Ethics of the Computer Society of India (CSI). I further undertake that I shall uphold the fair name of the Computer Society of India by maintaining high standards of integrity and professionalism. I was not a member of CSI earlier. I am aware that my breach of the Code of Ethics may lead to disciplinary action against me under the Byelaws and rules of the CSI. I hereby confirm that I shall be bound by any decision taken by the CSI in such matters. Further, I hereby convey my consent to receive the CSI publications in soft copy form and any other information about the activities of the society by email or by SMS on my Mobile number, from time to time, by the society or the members of the society.
Date :   
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