APPLICATION FORM FOR MEMBERSHIP
(see Rules and regulations 2.0 of All India ASECA – Regn. # S-30626-1996)
The President/General Secretary,
All India ASECA,
SFS Flat No. 326, Pocket 10
Sector 11 (Extension), Rohini, Delhi - 110 085
Dear Sir,
I desire to become a life member of this Association. I am giving below information in brief about myself. I shall furnish additional information if required. I shall abide by the rules and regulations of the Association.
- NAME (IN BLOCK LETTERS) _______________________________________________
- FATHER’S NAME _______________________________________________
- DATE OF BIRTH (d-m-y) _______________________________________________
- PERMANENT ADDRESS WITH
CONTACT # IF ANY _______________________________________________
_______________________________________________
- PRESENT ADDRESS WITH
CONTACT # IF ANY _______________________________________________
_______________________________________________
- EDUCATIONAL QUALIFICATION _______________________________________________
- AREAS OF INTEREST _______________________________________________
- OCCUPATION /PRESENT JOB
(DETAILS OF THE PRESENT
JOB WITH ADDRESS) ________________________________________________
_______________________________________________
- MEMBER OF ANY OTHER
ASSOCIATION IF YES GIVE
DETAILS ________________________________________________
- INDICATE YOUR OPTION FOR
PAYMENT OF MEMBERSHIP
FEE OF Rs2011/- (*) _______________________________________________
- ANY OTHER INFORMATION _______________________________________________
Date:_____________
Place:____________ (Signature)
* It may be one time or the applicant member may indicate his plan of payment. Drafts/Cheques may be drawn in favour of All India ASECA, New Delhi in Savings Bank A/c # 14827 at Indian Overseas Bank, Jeevan Deep Building, Parliament Street, New Delhi
FOR OFFICE USE ONLY
The applicant has been introduced by _____________________ and his application has been/has not been approved in the ________________ meeting held on ___________. He should be informed accordingly.
(Signature of President/Gen. Secretary)
Name:
Date :
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