Name of the Applicant in Block letters Qualification if any
Age
DOB
Mobile Number
Professional Address
Residential Address
Type of Membership requested Patron (Rs.1,00,000)Life Member (Rs.2000)
I request you to enroll me as a Patron • / Life Member •*, I do hereby agree to abide by the Rules and regulations of the Society and any amendments that may be made there from time to time. Further I shall stand by the values imbibed in the motto of service to the community without any selfish and self benefitting intentions.
* The Executive Committee shall accept or reject any membership form, if it feels or sees any threat to the unity of the Society and its mission to serve the community.
