International Society of Bengal Studies
Membership Form
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Email *
Contact Number *
Title *
Nationality *
Name *
Surname *
Occupation *
Designation
Institution *
Institutional Address *
Residential Address *
Mode of Payment *
Date of Payment
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Tentative date (please provide a tentative date if you do not remember the exact date, mentioning the correct month and year)
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Amount Paid *
Name of the Account to which / person to whom the payment has been made/ cheque has been issued/ internet transfer has been done. *
Name of the Bank and Branch from/through which OR name of the person to whom the payment has been made. *
Transaction No/Cheque No
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