INDIAN LEATHER TECHNOLOGISTS' ASSOCIATION
Regd. Office:Mercantile Building , Lalbazar St., East Gate, 'B' Block, Kolkata-700 001
Adm. Office: 44, Santipally, Kolkata-700 107. Phone: 24413459/Tele Fax :91-033-24413429

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APPLICATION FORM FOR MEMBERSHIP
Application for: □ Life Membership □ Ordinary Membership □ Honorary Membership
 □ Associate Membership □ Institutional Membership
Name of the Applicant:
(BLOCK LETTERS)

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*** 
Stamp Size
Photograph
Father's Name: ..................................................................................
Date of Birth: ..................................................................................
Blood Group: ..................................................................................  
Present Address: ........................................................................................................................
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Permanent Address: ........................................................................................................................
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Office Phone No.:  
     
Residence Phone no.:

Mobile Phone No.:
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.............................                               Email Address: 		....................................
**Educational Qualification
**Professional Experience
Extra curricula activities

Specialisation in the field of

 

 

    



 
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Date
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Signature of the applicant
*Proposed by:  *Seconded by :

Name............................................................

Name..................................................................
Address......................................................... Address...............................................................

Signature...........................
Signature...................

Observation of Membership Committee: 

Approved

Remarks

 Signed

Approved  under E.C. No.:

_____________________
General Secretary

* Proposer and Seconder must be a Member of ILTA
** Copies of the certificates both for Educational qualification and Professional experience duly attested by a member of the Association or by a Gazetted officer.
*** 2 copies of stamp size photographs Should be enclosed with application Form.
**** A Separate sheet may be used for Qualification / experience / vocational activities etc. if it  requires more space. 

Website: www. iltaonleather.com                    E-mail: leather1a@bsnl.in

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