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LIFE
MEMBERS.......
ABOUT
LIFE MEMBERSHIP
Interested artists and art lovers can join a life membership by
paying Rs. 1000/-. The amount will be utilized for the development
programmes of art and literature. The life members' photo will be
displayed on our website
www.kshitij.org
Life
Membership Application Form
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To
The
Secretary,
Kshitij,
642,
Sector-4, Urban Estate,
Gurgaon-122001
(Haryana)
India |
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Attach
Your
Two
Latest Passport Size
Photos.
Please
Do Not
Paste
it.
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Applicant's
Name:..............................................................................................................................................
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Father's/Husband's
Name:................................................................................................................................
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Date
of Birth &
Place:..................................................
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General
Qualification:..................................................
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Technical
Qualification:...............................................
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Occupation:.................................................................
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Permanent
Address :
........................................................................................................................................
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............................................................................................................................................................................
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Ph.
No :..............................
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Fax
:............................
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Email :
............................................................................
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Correspondence
Address :
...............................................................................................................................
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............................................................................................................................................................................
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Ph.
No :..............................
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Fax
:............................
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Email :
............................................................................
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Any
other information
:....................................................................................................................................... |
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............................................................................................................................................................................
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I
hereby declare, the above mentioned facts are true to the best of my
knowledge. I agree to abide
by
the rules and regulations of the Kshitij.
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| I
herewith enclose Rs. 1000/- by cash or
D.D.
(in favour of “Kshitij”,
payable at New Delhi or Gurgaon)
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| Demand
Draft No. ................................ Dated
..........................
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| Date:........................ |
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Signature of
Applicant |
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(Printout/ Copy/ Photocopy can be used.)
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