Website:

www.fpsindia.org
FLUID POWER
SOCIETY
OF INDIA (Regd.)

MEM.NO.
No.86, 1st Floor, 2nd Main, Vyalikaval, Vinayaka Circle, Bangalore
- 560 003
Tele fax: 080-23340917; Mob: +91 9986504001 ;
E-mail: fpsi.regd@gmail.com
1. EDUCATIONAL QUALIFICATIONS
Course / Degree
College / University

APPLICATION FOR INDIVIDUAL MEMBERSHIPYear of Passing

NAME..
(BLOCK LETTERS)
2. PROFESSIONAL CAREER
DATE OF BIRTH...
Name of Organisation
From
To
Position
NATIONALITY...
OFFICIAL ADDRESS

..PIN.
TLEPHONE FAX...
E-MAIL
RESIDENTIAL ADDRESS
..

...PIN... TELEPHONE..

Indicate the Mailing Address

by tick

3.MEMBERSHIP OF OTHER PROFESSIONAL BODIES

Professional Body

Class of Membership

Member Since

4. TECHNICAL PAPERS PRESENTED / ARTICLES PUBLISHED (if any)

Title of the Paper / Article

Name of the Conference/Journal in which Published

Date of Publication

DECLARATION
I, the undersigned certify that the statements contained herein are true. I agree that in the event of my election to any
grade of membership, I will be governed by the constitution of Fluid Power Society of India, Bangalore as they are now
formed or as they may hereafter be altered. I will advance the objectives and activities of the society so far as lies in my
power and will not do anything harmful to the image of the Society.

Date_________

____________________
Signature of Applicant

Completed document must be sent to the General Secretary FPSI together with the Xerox copies of Certificates &
required fees in the form of Crossed * Cheque/DO drawn in favour of the Fluid Power Society of India,(Regd.),
payable at Bangalore. (* Outstation cheques should include Bank Charges).

Dated ___________________
DD/ChequeNo._______________________ For Rs.______________
Drawn on_____________________________________________________ (Name of the Bank)

.
.
.
.

1. Membership Eligibility Criteria

Member
- Graduate in engineering / technology with minimum 10 years experience
,

Associate member
Graduate Member
Technical Member

in industry and age not less than 35 years.

- Degree/Diploma in engineering with minimum 7 years experience and age not less than
28 years.
- Degree in Engineering from a recognized University.
- Age 17 years on the date of his application and shall possess an educational qualification
recognized by the Council and an interest in the field of Fluid Power

2. Amounts indicated are towards admission fee and first year subscription. For subsequent years, the amount
indicated as subscription apply.

FOR OFFICE USE ONLY

Acknowledged on.

Graded as: .(Grade of Membership)

Note: Refer overleaf for eligibility criteria

Amount of DO /Cheque...................................
Date of Gradation: .
* (Rs. 500 Admission + Rs. 400 Yearly Subscription) - Member
(Rs.Date......................................
300 Admission + Rs. 300 Yearly Subscription) - Associate Member
Date Chairman Gradation
(Rs. 150 Admission + Rs. 200 Yearly Subscription) Graduate Member
Committee
(Rs. 100 Admission + Rs. 100 Yearly Subscription) Technical Member
Secretariat
(Rs. 100 Admission + Rs. 100 Yearly Subscription) - FPSI
Student
Member
($ 30 Admission + $ 60 Yearly Subscription) - Foreign Member