CLUB MEMBERSHIP FORM

DATE OF JOINING MEMBER NUMBER

STAFF USE ONLY

MEMBER DETAILS PLEASE PRINT CLEARLY (*Mandatory information)

*First name: *Residence address:

*Last name: :

*Date of birth:

*Contact number: *City / State:

*Email: *Postcode:

PROFESSIONAL DETAILS
Designation :____________________________ Organisation__________________________________________

Office address :_________________________ Contact number________________________________________

My membership is being proposed by the following two club members of the Bidhan Nagar (Salt Lake)
Kishore Sangha.

Name : ________________________________ Name: __________________________________

Signature: _____________________________ Signature: _______________________________

I HEREBY AGREE TO ABIDE BY THE PRESENT AND FUTURE RULES OF BIDHANNAGAR ( SALT LAKE) KISHORE
SANGHA.

Signature

FOR CLUB SECRETARY USE

I confirm that the board of executives has approved this member for membership in this club.

Signature of Secretary:___________________________________________________________