MEMBERSHIP APPLICATION

I/We wish to join Indian Red Cross Society (please indicate one from following):
Patron...Rs. 20,000/-
Vice Patron...Rs. 10,000/-
Life Member.Rs.500/-
Life Associate...Rs.250/-
Annual Member.Rs.50/- per annum
Annual Associate...Rs.10/- per annum
Institutional Member..Rs.1,000/- per annum
Please make DD / MO / Cheque in favour of:
Indian Red Cross Society, [name of the branch providing membership]
Name: ________________________________________________________________________
Blood Group: _______________________________Qualification:________________________
Destination: ___________________________________________________________________
Organization: __________________________________________________________________
Address: ______________________________________________________________________

City_________________________________________________________________________
State: __________________________________Postal Code: ____________________________
Tel: ___________________________________Fax: ___________________________________
Email: ________________________________Website: ________________________________

Signature: _____________________________Date: ___________________________________

I also wish to become a volunteer of the IRCS

Field of Specialization: __________________________________________________________

Introduced by: _________________________________________________________________

Address: ______________________________________________________________________