APPLICATION FORM FOR MEMBERSHIP OF COMMON CAUSE.

1. Name:

2. Father's Name:

3. Mother's Name

4. Date of Birth:

5. Educational Qualification:

6. Occupation:

7. Permanent Address:

8. Mailing Address:

9. Next of Kin (Name & Address):

10. Membership Sought. ( Tick any one block):

 

Individual

(with voting rights)

Ordinary

(Rs.500/- p.a)

Life

(Rs.2500/-p.a)

Associate

(without voting rights)

Ordinary

(Rs.100/- p.a)

Life

(Rs.500/- p.a)

 

 

11. Why do you wish to join COMMON CAUSE (upto 80 words)

 

 

 

 

 

 

12. Your expectations from COMMON CAUSE (upto 40 words)

 

 

 

 

Place & Date:

Signature

 

 

 

July - November 2007