Date : ____________
Place : ____________
The Principal,
Dear Sir,
I wish to apply for Ordinary / Life / Patron * Membership of
the Association. Required particulars have been furnished overleaf. I agree to abide by the Memorandum of Association / Constitution and
bylaws / rules and understand that my admission is subject to the approval of the
Executive Committee.
Enclosed is the Ordinary / Life / Patron * Membership fee of $
______ Dollars.
( * Delete two of three categories as desired )
Thank You,
Yours Sincerely,
Signature
1. First Name :
_________________________________________________________2. Middle Name : ________________________________________________________
3. Surname : ____________________________________________________________
4. Date of Birth : Month________Date__________Year___________
5. Educational Qualifications : ______________________________________________
6. Studied at Jai Hind College : From Year__________To Year_________
7. Martial Status : Married / Single
8. No. of children : _____
9. Names of children, if any, who are Alumni of Jai Hind College : ___________________
______________________________________________________________________
10. Residence Address : ____________________________________________________
______________________________________________________________________
Pin ______________
Res. Tel. __________________
11. Company / Organization : ________________________________________________
Address : _______________________________________________________________
_______________________________________________________________________
Pin ______________
Designation _____________
Off. Tel.____________
12. Nature of Business : ______________________________________________________
13. Can assist with : _________________________________________________________
14. Correspondence / Communication to be sent to
Residential / Office * Address
( * Delete one as desired )
Date _______________
Signature ______________________
FOR OFFICE USE ONLY
RECEIVED _______________________ APPROVED_______________ INTIMATED____________
CHEQUE / DRAFT - AMOUNT $ _______________________
NO.______________ DATED_____________ DRAWN ON_____________________
RECEIPT NO._______________ DATED________________
MEMBERSHIP NO.__________/______ ______ _____ _____