CENTRE FOR SCIENCE & TECHNOLOGY

OF THE NON-ALIGNED AND OTHER DEVELOPING COUNTRIES

(NAM S&T CENTRE)

Core 6A, 2nd Floor, India Habitat Centre, Lodhi Road, New Delhi-110003 (INDIA)

Phone: (+91 11) 24645134, 24644974; Fax: (+91 11) 24644973

E-mail: namstct@gmail.com Website: www.namstct.org

NAM S&T–INDUSTRY NETWORK

1. Name and Full Address of the Organisation:

Phone:

Fax:

E-mail:

Website:

2. Name and Designation of the Head of the Organisation:

Director Phone, if applicable:

E-mail:

3. Number of Employees:

    i) Scientists and Technologists                                             ii) Others

4. Principal Areas of R&D Interest:

5. Areas in which the Organisation can provide Consultancy/
    Technical Assistance to the Developing Countries:

6. Any other relevant information:

7. Details of Annual Membership Subscription Enclosed/Transferred

            For Scientific Agency/R&D Institutions/Science Academy/Industrial Organisation       US $4000

     For the period 1^st April _________ to 31^st March ___________

     (Or for the Financial Year of the Country beginning ……………………..)

(To be paid either (a) through bank transfer to our Account No. 52011023771 at the Standard Chartered Bank. Hamilton House, Block –A, Connaught Place, New Delhi – 110 001, India, Swift Code: SCBLINBBXXX, or (b) through bank transfer to our Account No. 52142908231 at the State Bank of Hyderabad, Scope Complex Branch, Core 6,7, Institutional Area, Lodhi Road, Pragati Vihar, New Delhi – 110003 India Swift Code SBHYINBB012 under intimation to us or (c) through cheque/draft drawn in favour of “Director, NAM S&T Centre, New Delhi”.

Date:                                                                    Signature of the Head of the Organisation

1. Name and Full Address of the Organisation:	Phone:
	Fax:
	E-mail:
	Website:
2. Name and Designation of the Head of the Organisation:	Director Phone, if applicable:
	E-mail:
3. Number of Employees: i) Scientists and Technologists ii) Others
4. Principal Areas of R&D Interest:
5. Areas in which the Organisation can provide Consultancy/ Technical Assistance to the Developing Countries:
6. Any other relevant information:
7. Details of Annual Membership Subscription Enclosed/Transferred For Scientific Agency/R&D Institutions/Science Academy/Industrial Organisation US $4000 For the period 1^st April _________ to 31^st March ___________ (Or for the Financial Year of the Country beginning ……………………..) (To be paid either (a) through bank transfer to our Account No. 52011023771 at the Standard Chartered Bank. Hamilton House, Block –A, Connaught Place, New Delhi – 110 001, India, Swift Code: SCBLINBBXXX, or (b) through bank transfer to our Account No. 52142908231 at the State Bank of Hyderabad, Scope Complex Branch, Core 6,7, Institutional Area, Lodhi Road, Pragati Vihar, New Delhi – 110003 India Swift Code SBHYINBB012 under intimation to us or (c) through cheque/draft drawn in favour of “Director, NAM S&T Centre, New Delhi”.
Date: Signature of the Head of the Organisation