ECOTOURISM AND CONSERVATION SOCIETY OF SIKKIM
 State Archives Annexe, Zero Point, Gangtok 737 101 Sikkim India
Tel: 29154, 28211, 25182 Fax - 29183 Email : ecoss@sikkiminfo.net  

MEMBERSHIP ENROLMENT FORM
Membership Category : Individual  Honorary
Name :
Date of Birth : (DD/MM/YY)
Name of employing organization or self employed :
Position Held :
Mailing Address:
 
   
State:  District : Postal Code :
Country :
Telephone (Home) :
(Office): (Fax):
E-mail :
Mobile Phone :
Select the one that best describes you :
Student  NGO Member 
Professional  Retired 
Government/Public Service 
Any Other :
I hereby agree to the terms and conditions of the membership as mentioned and amended from time to time in the constitution of ECOSS

 
…………………..
Signature :                                                                       

We would appreciate if you could kindly highlight your area of specialization, expertise or field of interest on the back of this form. We need to have a record of the useful resources within our organization. 

Thank you.
*Print this form & send it to: Renzino Lepcha, Executive Secretary, Ecotourism and Conservation Society of Sikkim, State Archives Annexe, Zero Point, Gangtok, Sikkim - 737101, India. Phone :0091- 3592 - 29154, 25182, 28211, Fax: 0091 - 3592 - 31276 , Email : ecoss@sikkiminfo.net
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FOR OFFICE USE ONLY

Membership Fees Paid Rs……………….. Vide Cash/Cheque No. ……………… Dated ………………….
Date of Admission to membership ……………………….
Membership Approved by ……………………………….
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