APPLICATION FORM FOR MEMBERSHIP

THE WEST BENGAL MUSLIM ASSOCIATION

ESTABLISHED: 1995                MOBILE: 09732606970, 9432895947, 9831685793

69, Elliot Road, KOLKATA-700016

APPLICATION FORM FOR MEMBERSHIP        NO:

            I would like to become a Life / General / Institutional / Monthly / Annual Member of the WB Muslim Association. My particulars are given bellow:

            I agree to abide the Rules and Regulations/ By Laws of the WBMA.

            The amount of Rs. 100/- for General Annual Member / Rs. 5000/- /Life Member

Rs. 1000/ and Institutional Annual Member Rs. 500/ for the session year 2010-11.is paid herewith.

NAME IN FULL……………………………………………………………EDUCATIONAL QUALIFICATIONS………………………………………

FATHER’S/HUSBAND’S NAME: ………………………………………

PRESENT ADDRESS: ………………………………………………………………………………………………

…………………………………………………PHONE………………

PERMANENT ADDRESS…………………………………………………………………………………

…………………………………………..PHONE………………………………………..

AGE……………………..RELIGION………………..OCCUPATION…………………

SERVICE ……………………………………………………………

ACTIVITIES INTERESTED IN………………………………………………

MEMBERSHIP OF OTHER SOCIETIES/PARTY…………………

DATE / PLACE OF APPLICATION…………………………..                            

SIGNATURE OF APPLICANT

PROPOSED BY……………….CATEGORY OF MEMBER……………

APPLICATION CATEGORY & RECEIVED ON………………

CONSIDERED AND RECOMMENDED /REJECTED/DEFFERED BY MEMBERSHIP COMMITTEE

PRESIDENT ….…………………………..………………………………

GENERAL SECRETARY……………………………………….…………

New Information, complain or enquiry send to

The General Secretary
THE WEST BENGAL MUSLIM ASSOCIATION
69,

Elliot Road

, Kolkata-700016.India
Ph : 91-09732606970, 09432895947
         

Email: westbengalmuslimassociation@gmail.com