Membership Application Form

PRITINAGAR MAITRI SANGHA

& SHANTI SMRITI PATHAGAR

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

Father’s / Husband Name:

Present Address:

Date of Birth:

Email ID:

Contact No:

Date:

Reference Receipt No.:

Membership Type:
[radio membership-type use_label_element \”Life Member\” \”General Member\”]

Upload Photo:

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Dear Sir/Madam,

I would like to be a Life / General Member of your esteemed organization.
I agree to obey the constitution of the organization.

Date:

Signature:

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Applicant Details (Second Section)

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

Occupation:

Present Address:

Pin:

Father’s / Husband Name:

Email ID:

Contact No:

Date of Birth:

Blood Group:

1. Proposed By (3 years standing member):

Address: