Electronics Hobby Centre

Membership Form 2011-12

Name: _____________________________________________________________________________
ID: _______________________________________________________________________________
Course: ____________________________________________________________________________
Email ID: __________________________________________________________________________
Room No.: _________________________________________________________________________
Contact No.: ________________________________________________________________________
Please select any one of the membership options
1 year (Rs. 150/-)
2 years (Rs. 275/-)
4 years (Rs. 350/-)
Why do you want to join EHC?
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Do you want EHC to plan any particular event?
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________

Date

Signature of Applicant