Membership « The Bengal Association | Chennai

Membership

29, Giri Road,
T.Nagar,
Chennai 600017

Application form for membership

*All are mandatory fields

Dear Sir,

I Wish to enroll myself as a member of the The Bengal Association, Chennai. My details are as under

Merchant Id : Order Id : Amount : Currency : Redirect URL : Cancel URL :Language :
Name of the Applicant *
Father Name*
Address (Office)*
Address (Residence)*
Email( Personal ID preferably)*
Mobile Number*
Landline
Address for Communication* Office Residence
Date of Birth*
Name of the dependent Members of the family with relationship and age*
Introduction
Proposed by*
Email*
Seconded by*
Email*
Additional Information
How did you come to know The Bengal Association, Chennai
How long you are residing in the mentioned address / Chennai
Are you a member of any other association / Club (Please Mention)
Is there any other person from your family who is the member of this association
Please specify your profession
Please mention your area of interest (pls tick)
Puja
Cultural Activities
Administration
Organizing Events
Photography
Fund Raising
Library
Vocational Training
Sports
Is your Spouse is also a member in The Bengal Association* Price

Date:


* The Information Provided by me is true to my knowledge. I agree to abide by the rules and regulation of the The Bengal Association, Chennai.
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