National HRD Network
C81C, DLF Supermart-1, DLF City, Phase IV, Gurgaon,
Haryana -122002
membersupport@[Link]
INDIVIDUAL MEMBERSHIP FORM
Type of Membership applied for: (Please tick)
Annual
Life
Chapter of Preference ____________________
Title (Please tick)
Mr
Ms
Mrs
Dr
Prof
1. First Name:____________ Middle Name:________________ Last Name:_____________________
2. Current Organizations Details
Name & Complete Address
Industry/Sector
Current Role
Contact Information
Telephone
Fax
Official E-mail ID
3. Correspondence Communication Address:______________________________________________________
____________________________________________________________
City: ______________ State: __________ Pin Code: __________ Resi. Contact # _______________
4. Permanent Address: _____________________________________________________________________
(Please fill: in case if it is different from correspondence address)
City: ______________ State: __________ Pin Code: __________ Resi. Contact # _______________
5. Mobile #: _________________________
6. Personal Email ID:________________
7. Date of Birth:_________________________
Marital Status : _________________________
8. Total Work Experience:_____(yrs.)__________(Months) As on _________
9. Professional Qualification:
S. No.
Course
Yr. of Passing
(Add More)
10. How did you come to know about NHRDN: (Please tick)
National HRD Network All Rights Reserved
Institute
University
NHRDN Website
Newspaper/Magazine
Reference from Friends/Colleagues
Conference/Seminars/Training Programmes
NHRDN Webinar
Others _____________________
11. If referred by Friends/Colleagues:
Name of the Member: __________________________
Membership No. _____________________
12. Please provide any 2 reference who would like to become NHRDN Member
Name: __________________________
Contact No. _____________________
Name: __________________________
Contact No. _____________________
13. In what manner you would prefer to be associated with NHRDN
Special Events
Conference/Seminars/Webinar/Learning Centers & other Training Programmes
Volunteering in Special Projects & Events
Others, please specify ______________________________________________
14. Member of other Professional Bodies:
Yes
No
If YES, Please specify_________________________________________
15. I would like to receive updates from National HRD Network:
Yes
No
I am interested to become member of National HRD Network and accordingly have
provided the desired particulars. I do agree to abide by the rules and regulations of National
HRD Network. Enclosed are the Cheque/Bank Draft No._________________ Dated__________ in
favor
of
National
HRD
Network
for
Rs.
___________
(Rupees______________________________________) towards the membership.
I declare that the statements made through this application are correct to the best of my
and belief and that I agree to be governed by the By-Laws of the National HRD Network
(NHRDN) as, they now exist and hereafter if they be altered. I further undertake that I will
promote the objectives of NHRDN. If at any time I fail to comply with the requirements if the
NHRDN with regards to the membership, I undertake to return the Membership ID Card and
privileges associated with the membership. I also undertake to abide by the NHRDN Code of
Conduct that the NHRDN National Executive Board may frame from time to time.
Date: _______________________
National HRD Network All Rights Reserved
Signature: _________________________
