Prerana Membership Form

Form No.

PRERANA T H E

I N S P I R A T I O N Reg No: S/1L/54406

MemberRegistrationForm (Use only CAPITAL Letters & blue or black ink) (Read the terms & conditions carefully) First Name : AFFIX A PASSPORT SIZE COLOR PHOTOGRAPH HERE

Last Name :

Gender: M / F (Tick above √ ) Address : (Please include C/o if applicable)

Pin Code : Home Telephone No. (with area code) :

Date of Birth (dd / mm / yy) : / /

Mobile No. :

Occupation :

Email ID: Educational Background: Opening contribution :

Your kind of activity (tick √ ): Areas of interest (tick√ ): Manage volunteer programmes : Fund raising programme : Financial Management : Website management : Blog management : Database creation & management : Participate in communication activities :

Financial help : Volunteer for PRERANA : Your Remarks :

Signature of President Stamp of Organization

I agree all the terms & condition of the organization.

Signature of Secretary

Signature with date Terms & Condition: 1. You must be atleast 18 yrs old 2.You should be like-minded with the objectives of our organization. 3. Members can be from any creed, cast & religion. 4. If we found any moral malpractice in your social activities membership will be cancelled with out any notice. 5.It is a non-profit organization & you have to serve here without expecting any monetary profit. 6.You must pay membership subscription within 10th of month.