Indian Chamber of International Business

Mumbai Office: 702 A Sorento, Shanti Park, Ghatkopar East, Mumbai 400077, India. Tel: +919137784411, Email: office@icib.org.in Web: www.icib.org.in

Membership Application for ROTARIANS

(Valid for 3 years from Enrolment)

Name : ____________________________________________________________
Address : ____________________________________________________________
Phone : ____________________________________________________________ Paste Photo
Mobile : ____________________________________________________________ Here
Email : ____________________________________________________________
Website : ____________________________________________________________
Nature of Business / Profession:_____________________ Sector:_______________
Rotary Membership Number:___________________________________
Rotary Club Name and district: ___________________________________________

Membership: □ Individual □ Organisation

Indian Resident Others Indian Company Others

(INR) (USD) (INR) (USD)

□Rotarian 5000/- 100 $ 10000/-(One Member) 150/- (One Member)

□Rotaractor 2500/- 50 $ 10000/- (One Member) 250 $

□Family Member 5000/- 100 $ 10000/-(One Member) 150/- (One Member)

□Honorary NIL NIL NIL(One Member) NIL $

□Patron 100000/- 2000 $ 151000/- (Two members) 5000 $

Please attach the following documents along with the application:

• A brief profile
• Government approved Identity Card along with Address Proof
• Business Registration copy (for corporate or company memberships)
• Membership certificate will be issued after scrutiny and approval by executive committee.
• Please make membership fees payable to “Indian Chamber of International Business”.

Mumbai New Delhi Kolkata Chennai Amritsar