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MEMBERSHIP APPLICATION FORM Name Designation Date of Birth Organization Correspondence Address : : : : :

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Land Line Number Email Mobile Number Membership Type Membership Fees

: : : : Annual : Rs. 500/- ( Five Hundred Only)

Payment Details: DD/Cheque in favour of: MTC Global Trust, Payable at Bangalore DD/Cheque No. Date Amount Bank Name & Branch

OR You may send the fees electronically with a confirmation mail to president@mtcglobal.org to the following a/c for your convenience: Account Name: MTC Global Trust Account Type : Savings A/C IFSC Code : PUNB0606300 Account Number : 6063000100011431 Bank Name : PUNJAB NATIONAL BANK Branch : Mahadevpura Branch, Bangalore, India

Send in your application duly filled along with remittance to:


PROF. BHOLANATH DUTTA MBA DEPARTMENT CMR INSTITUTE OF TECHNOLOGY NO- 132, AECS LAYOUT, IT PARK ROAD, BANGALORE- 560 037 Cell: +91 96323 18178

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[MTCians are encouraged to send the soft-copy of the membership form and also membership fees through NEFT to avoid postal/courier charges and loss of mail.]