Platinum Membership Application Form

PRITINAGAR MAITRI SANGHA

Applicant Name (Mr./Mrs./Miss):

Father’s / Husband Name:

Present Address:

Date of Birth:

Email:

Contact No:

Date:

Reference Receipt No.:

Platinum Member No.:

Upload Photo (Passport Size):

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Application Letter

Dear Sir/Madam,

I am a life/general/non-member of your esteemed organization.
I am interested in getting Platinum Membership in the Platinum Year 2026.
I agree to obey the constitution of the organization.

Date:

Signature:

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Personal Details

Occupation:

Present Address:

Pin:

Father’s / Husband Name:

Email ID:

Contact No.:

Date of Birth:

Blood Group:

Proposed By (3 Years Standing Member):

Address: