ID No:

THE OFFICIAL ARSENAL NEPAL SUPPORTERS CLUB

Proposed Member Particulars Form 2013/14

1. Member Name (IN BLOCK LETTERS)

(Dr/Er/Mr/Mrs/Ms)
First Name Middle Name Last Name

2. Members Address / Contact Information:

Permanent address:

Temporary address:

Email ID: .., Telephone No:

Mobile: Residence:

3. Identification
Nationality: ..

Date of Birth (DD/MM/YYYY) / Gender: / Male Female

4.

Present Status:

Student

Self-employed

Unemployed

Employed

Company / School Name:

Post:

Your preferred Name to be shown on the Membership card: (in block letters)

Polo T-Shirt:

Size: (Men) XS / S / M/ L / XL / XXL (Kid/lady) S / M / L

Membership Type:

Renewal

New Entry

I declare that the particulars herein given by me are true and correct and that I have not willfully suppressed any material fact.

Date

Members Signature

(All membership acceptances will be subjected to nal approval by Board of Committee)

For Official Use

Membership Approve: Yes / No Membership Type:

Date

President / Secretary of ASC

Note: All forms should contain a passport size photo and a photocopy of your citizenship or any valid identification attached to this form.