LIFE MEMBERSHIP FORM

Date: *

Form No.: *

To,

The President/Gen.Secretary

Shree Padmashali Telugu Samaj Sangham

Indira Nagar H.D.CHS,Sion Koliwada(E)

Mumbai - 400 037

Dear Sir,

I hereby agree and undertake to abide by all the rules & regulation of the sangh.
I request you to take me as Life Member.

Full Name Shri/Smt./Kum.: *

Father's/Guardian Name:

Mother's Name:

Date of Birth:

Age:

Education Qualification:

Residential Address:

Area: *

Pincode: *

City: *

State: *

Mob.: *

Office Address:

Area:

Pincode:

City:

State:

Tel.:

Native Place Address:

Area:

Pincode:

City:

State:

E-mail Id:

WhatsApp Mobile Number.:

Hobbies:

Aadhaar Card Number.: *

All the above furnished information is true & correct.
If I change my current address I will inform to sangh.

Introduced By:

Signature of the Applicant: *

Life Membership No.:

Encl.: Aadhar Card, Ration Card, Xerox, and Stamp Size 2 Photos.

MEDICAL CAMP-2017