Membership Form – Kalyanam Karoti – from darkness to light
KALAYANAM KAROTI, MEERUT (REGD.)
A SOCIAL ORGANISATION DEDICATED TOWARDS ERADICATION OF BLINDNESS, AND HELPING THE HANDICAPPED AND AGED PERSONS
CANTONMENT GENERAL HOSPITAL, BEGUM BRIDGE, MEERUT CANTT – 25001
LIFE MEMBERSHIP FORM
To,
THE PRESIDENT,
KALAYANAM KAROTI, MEERUT
Sir,
_________________________________on becoming life member of KALAYANMA KAROTI, MEERUT, I will abide the rules of the society, and dedicate myself towards the fulfillment of its objectives.
My particulars given hereunder are true to the best of my knowledge and belief;
Father’s / usband Name: Shri__________________________________________________________
Date of Birth: ______________________________________________________________________
Date of Marriage: ___________________________________________________________________
Educational Qualifications: ____________________________________________________________
Residential Address: _________________________________________________________________
_____________________________________________________Phone: _______________________
Profession: ________________________________________________________________________
Business / Professional Organisation: ___________________________________________________
__________________________________________________________________________________
_____________________________________________________Phone:_______________________
Association with otehr social organisation (Past / present)
Organisation: Post Held / Ordinary Member
Organisation:
1. _______________________________________________________________________________
2. _______________________________________________________________________________
3. _______________________________________________________________________________
Any other Information: ______________________________________________________________
Hobbies: __________________________________________________________________________
Dated: Signature of applicant
Name of the proposer assocaiated with Kalayanam Karoti___________________________________
Signature of the proposer Accepted / Rejected
President General Secretary