SAMBRIDHI OSU EUAN BD FOUNDATION Membership Application Form CIN: U85320WB2020NPL237941 XY *Personal information:** Full Name Date of Birth: Gender: [] Male [] Female [] Other Nationality: Residential Address: City: State/Province: ZIP/Postal Code: _ Country: Email Address: Phone Number: _ **Membership Details:** Membership Type: [ ] Individual [ ] Family [] Corporate Membership Category: [] Regular [] Premium [] Lifetime Membership Fee Paid: __ How did you hear about us? _ (if applicable) **Declaratic thereby apply for membership in [Trust Foundation Name] and affirm that the information provided in this form is true and accurate to the best of my knowledge. | understand and agree to abide by the foundation's rules, regulations, and code of conduct. ! also understand that my membership may be subject to approval by the foundation's board. Signature: Date: Payment Information (if applicable): Payment Method: [] Credit Card [] Cheque [ ] Bank Transfer Bank Transfer Reference (if applicable} Collector Signature: _ - Receiver Signature: _ Please return this completed form to [Foundation Address] or email it to [Foundation Email Address] ‘Thank you for your interest in becoming a member of [Trust Foundation Name]. Your support is greatly appreciated. an AOMEUKK Eye LC e nee C01 CoC UE