APPLICATION FORM

Name: _________________________________________________________________

Father’s Name:__________________________________________________________

Mother’s Name: _________________________________________________________

Date of Birth:____________________________________________________________

Educational Qualification:__________________________________________________

Occupation:_____________________________________________________________

Permanent Address:______________________________________________________

Mailing Address: ________________________________________________________

  1. Email ID :_________________________________________________________
  2. Phone : Mobile:____________________________________________________

Next of Kin (Name & Address):_____________________________________________

Membership Sought. (Tick any one block):____________________________________

 

              Categories

            Ordinary

           Life

         Individual (with voting rights)

             Rs. 500.00 P.A.

        Rs. 5000.00

      Associate (without voting rights)

            Rs. 100.00 P.A.

         Rs. 500.00

 

  1. Why do you wish to join COMMON CAUSE (up to 80 words)

  2. Your expectations from COMMON CAUSE (up to 40 words)

Place & Date: ____/_____/______                                         Signature : ___________________

Volume: Vol. XXXV No. 2
April-June,2016