AKASHVANI & DOORDARSHAN

ADMINISTRATIVE STAFF ASSOCIATION

(NATIONAL COUNCIL) (Regd)

--Enrolment /computerization of Membership of ADASA and issuance of Association I.Card.

To
The General Secretary
ADASA, New Delhi.

PHOTOGRAPH

Sir,
I_______________________________________ hereby submit my willingness to be
enrolled as a member of the ADASA and shall abide the rules, regulations, byelaws of the
Association. I have paid the requisite enrolment fee and membership fee. My Bio-data is as
under:Date:
(Signature)
____________________________________________________________________________
Members Bio-data
1.

Name in full

______________________________________________

2.
3.
4.

Designation
:
______________________________________________
Name of Station/ Kendra/Office
:
________________________________________________
Date of joining Department
:
________________________________________________

5.

Date of birth

________________________________________________

6.

Qualifications

________________________________________________

7.

Contact No.

(Mob.)___________________________________________
(Tel..)(Off.)With STD Code:__________________________
(Tel..)(R) with STD Code:____________________________

8.
9.

E-mail(if available)
Permanent Address

:
:

_________________________________________________
________________________________________________
___________________________________________________
Pin Code:

10. Present Residential Address:

`

______________________________________________________
Pin code_______________________

(UNIT SECRETARY)

(ZONAL SECRETARY/CHAIRMAN)
(GENERAL SECRETARY/PRESIDENT)

ENROLLED MEMBERSHIP NO: ______________(To be allocated by National Council)