Name: __________________________________________________________________________________

Membership Scheme: Family

Individual/ Ordinary

Student

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Member Data:
Username (desired or existing) in Malayalanatu web magazine: _____________________________________
Username in Facebook/ as in Facebook page of mfcc: _____________________________________________
Date of Birth:_______________________________________________________________
Address for correspondence: __________________________________________________
__________________________________________________
__________________________________________________
Permanent Address and Communication:_________________________________________
_________________________________________
__________________________________________
E mail:_____________________________________

Fax:______________________________

Phone:_____________________________________

Mobile:___________________________

Academic Qualification:_____________________________________________________________
Area of Emloyment/ Business Area/ Industry: ___________________________________________
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In case of Family Membership

Spouse Data:
Name:___________________________________________
Birth Date:________________________________________
Mobile:___________________________________________
Nationality:________________________________________
E mail:____________________________________________
Children Data:
Name:__________________________________

Name:______________________________________

Birth Date:_______________________________

Birth Date:___________________________________

E mail:__________________________________

E mail:______________________________________

DECLARATION

Being a member, I agree to accept to pay the prescribed yearly subscription, to abide by the rules of the organization,
to contribute to the foundation’s growth and welfare and to promote its’ aims and objectives.