Membership Form

ANMOL PRAYAS
Reg. No. 1805-2013-2014
(A NGO empowering underprivileged through education and skill development)
Reg. Office ; - 345, Sahara Shopping Centre, Faizabad Road , Lucknow (UP), PIN 226016
Contact Nos.: +918979323738, +919919445198 & +919451061529
E-Mail: [email protected]
Membership Form
Affix your
Life/Ordinary
Name (In block letter) ………………………………………………………
photograph
Father’s /Husband’s Name ………………………………………………….
here
Date of Birth …………………………………………………...………….
Mobile No.
………………………….. Land Line No …………………………………...…
E-mail Address
………………………………………………………………….............
Communication Address
………………………………………………………………………………………………………
………………………………………………………………………………………………………
Permanent Residential Address
………………………………………………………………………………………………………
………………………………………………………………………………………………………
Qualification
…………………………………………………………………….….…
Occupation
……………………………………………………………………………
Association with any other NGO (if any, please give details and at which capacity) Yes/No
.……………………………………………………………………………………………………..
How would you like to contribute ………………………………………………………………....
……………………………………………………………….
I hereby declare that I have gone through the aims, objectives, terms and conditions of the NGO and I want to
contribute to its cause. I am sending herewith Rs.……………………..(Rupees……………………………
……………………………............only)as membership fee in cash / Cheque /DD No………………. Drawn on
………………………………………………………
Date………………………
Signature of the Applicant
For Office Use Only
Received Rs. ..................... (Rupees.........................................................................) And
Membership accepted and no. Alloted ..................... By ................................... On ...................
`