Mail the Completed Application to: isrdmembership@gmail.com All Rights Reserved London-press.

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INTERNATIONAL SOCIETY FOR RESEARCH AND DEVELOPMENT
ISRD Membership Declaration Form


TITILE
Dr/Prof/Mr/Mrs/Ms
Mr
For Office Use Only
Appl No:
NAME Balaji V

FATHER / GUARDIAN
NAME
Velusamy M
DOB
dd/mm/yyyy
10/07/1987 GENDER Male
NATIONALITY Indian
E-MAIL balajiaerospace@gmail.com
PERMANENT ADDRESS
5/7, Kaliappa Gounder Street,
Kavundam Palayam, Coimbatore, Tamilnadu
COUNTRY India PINCODE: 641030
DATA PROTECTION:
I understand and consent to the information provided on this form being processed by the ISRD for
its sole use and that of its associated organizations, including my Local Network, for the purpose of
promoting, delivering and improving my experience of the ISRD and its product and services or
such other purposes as are described in the ISRD Privacy Statement. If either now or in the future I
am based outside the European Economic Area (the EEA), my information may be transferred
outside the EEA (for example to my Local Network or ISRD Global Office) to enable me to benefit
from the ISRD opportunities overseas or, where required, to enable the ISRD to meet any legal or
other legitimate obligations in that country. ISRD products and services are enjoyed by our
members and customers globally.

DECLARATION:
I declare that the statements made on this form are to the best of my knowledge true. I agree to
comply with the Royal Charter and Bye-laws and Rules of Conduct of the International Society for
Research and Development (ISRD) and understand that this is a commitment to behave ethically
within my profession. I will do my best to promote the interests of the ISRD. I confirm that I have not
committed any offence of which the ISRD would require me to give notice under its Rules of
Conduct. The Rules of Conduct and the Royal Charter and Bye-laws are published on the website
www.london-press.org/membership/ and the Terms and Conditions of Membership can be found
http://london-press.org/terms-conditions/. I will obey all the conditions taken by ISRD time to time. If
elected, I will conform to the Constitution, Bylaws, Rules of Policy and Procedure, and Code of
Ethics of ISRD. I hereby agrees and commits itself to comply with the provisions of the statues and
rules of procedures of ISRD and all decisions taken by the ISRD assembly in future and present.

DATE: 29/09/2014
PLACE: Coimbatore

SIGNATURE OF APPLICANT
For Office Use: Application: Accepted /Status Application No: Approval No:
Membership Type: Membership ID: Certificate Delivery No:
Processed By: Validity: Certificate Delivered Date: