100 Rupee Club

Membership Form
100 Rupee Club is a charitable society of Indian nationals working worldwide. Our objective is to facilitate a dynamic link between Indians wherever they are with an aim to encourage voluntary philanthropic activities. In principle and practice, 100 Rupee Club values and seeks a diverse membership. The Association shall be non-party in politics and non-sectarian in religion. We are here to lend a helping hand to a brother or a sister who deserve your help! How can you join 100 Rupee Club? 1. Become an ACTIVE MEMBER by paying 100 Rupee per month or 1200 Rupee lump sum towards one year membership subscription to 100 Rupee Club. 2. If you can afford, become a LIFE MEMBER by paying Re 12,000 lump sum towards your subscription to 100 Rupee Club. 3. If your organization could help us, join as CORPORATE MEMBER by contributing Re 10,000 or more per year towards this noble cause. Please complete the online membership form below. [If you prefer to complete your membership application offline, please follow this link for a form that you can print, complete, and mail to us at (email address).

MEMBERSHIP APPLICATION
Membership Type ACTIVE MEMBER LIFE MEMBER

CORPORATE (Represented by ______________________________________________) PERSONAL DATA First Name*:

Surname*:

Age / Date of Birth*:

Blood Group:

Profession:

Employer:

Contact ( Number):

E-mail Address* :

MAILING ADDRESS:

City / Province* :

Postal Code* :

Country * :

PERMANENT ADDRESS (if different than above):

Panjayath :

District* :

State* :

Country *:

Postal Code* :

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