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Year: 2008 |
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| Date: |
___________ |
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| Name/s: |
1) ___________________________ |
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Membership No/s: |
1) _______________ |
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2) ___________________________ |
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2) _______________ |
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| Date of Birth: |
1) __________________ |
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2) __________________ |
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| Change of
Address/Telephone No. (If any):
_________________________________________________________________ |
| Paid Rs.
________________ /= Cash/Cheque No: ___________________ |
Date: ____________ |
| Bank/Branch:
________________________________________________ |
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| Temporary Receipt No:
_________________ |
Official Receipt No:
________________ |
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Chairman Membership Drive/Area Co-ordinator Signature |
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Treasurer's Signature |
| Please note children
having reached the age of 18 years should apply for new memberships. |
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_____________________
Member's Signature/Date |
