Receip

Receipt No.Date. Rs Membership No.

MEMBERSHIP FORM
1. Name of the Member

: ____________________________________________________________

2. Date of Birth

: ___________________________________________________________

3. Qualification

: ____________________________________________________________

4. Occupation

: ________________________________________________

5. Marital Status

6. Name of the Spouse

: ____________________________________________________________________

7. Date of Birth

: ____________________________________________________________________

8. Marriage Day

: ____________________________________________________________________

9. Do you have Children? :

10. No. of Boys

Married __________ Un-married_____________

YES _______

: _______________

NO ______

11. No. of Girls: _______________

12. Names of Boys: 1. _________________________________ 2. _______________________________________

13. Dates of Birth: 1._________________________________ 2. _______________________________________
14. Names of Girls: 1.___________________________________2._______________________________________
15. Dates of Birth: 1.________________________________ 2. ______________________________________
16. Address of the Church (OR) Parish you attend:
_________________________________________________________________________________________________________
17. Address for communication:
_________________________________________________________________________________________________________
18. Cell /Phone No: _____________________________ 19. Email : ______________________________________
Declaration:
I request you to enroll me as a member of the International Dalit Christian Freedom Rights Association. I am a
resident of______________________________ and I hereby agree to abide the Rules and Regulations framed
under the Bye-laws of the Society from time to time. I hereby declare that the above details are correct. I request you
to allot me membership.

Signature of the Member