APPLICATION FORM
1. Name: __________________________________________________________________
2. Father’s Name: ___________________________________________________________
3. Mother’s Name ___________________________________________________________
4. Date of Birth: _____________________________________________________________
5. Educational Qualification: ___________________________________________________
6. Occupation: ______________________________________________________________
7. Permanent Address: _______________________________________________________
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8. Mailing Address: __________________________________________________________
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(a) Email ID : _______________________________________________________________
(b) Phone :_________________________Mobile: __________________________________
9. Next of Kin (Name & Address): ______________________________________________
10. 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 |
11. Why do you wish to join COMMON CAUSE (up to 80 words) __________________
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12. Your expectations from COMMON CAUSE (up to 40 words) __________________
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Place & Date: Signature
