| |
INDIAN
RED CROSS SOCIETY
KERALA STATE BRANCH |
Affix
Stamp Size
Photograph |
|
and
DISTRICT BRANCH, ERNAKULAM - 682011
APPLICATION FORM |
| (Application for membership shall
be entertained only if it is recommended by a registered member of
the Indian Red Cross Society, Kerala State Branch. One stamp size
photo must be affixed and two copies shall be attached with the applicaion
form) |
| Type
of Membership Applied for |
: |
Patron
/ Vice Patron / Life / Annual member |
| Name |
: |
|
| Age |
: |
|
| Sex |
: |
|
| Occupation |
: |
|
| Qualification |
: |
|
Official
address, if any
|
: |
|
| Phone
/ Mobile |
: |
|
| E-mail, if any |
: |
|
Permanant
address
|
: |
|
Present
Residence address & Phone No.
|
: |
|
| Blood Group |
: |
|
| I wish to enroll myself as a
member of Indian Red Cross Society, Kerala State Branch / District
Branch / Taluk Branch (indicate place)______________________ I solemnly
affirm that the fundamental principles of Red Cross movement, namely
Humanity, Impartiality, Neutrality, Independence, Voluntary service,
Unity and Universality shall be up upheld by me and shall endeavour
to uphold the dignity of the movement. |
| |
| Date : Signature |
Name
of the member, who recommended
the applicant.
(Give full address & IRCS
Membership Number)
|
: |
|
| |
|
|
| Fee: |
|
|
| Patron |
: |
Rs 20,000/- |
| Vice
Patron |
: |
Rs 10,000/- |
| Life
Member |
: |
Rs 500/- |
| Annual
Member |
: |
Rs 50/- |
| |
|
|
| Fee
remitted |
: |
Rs ___________(Rupees______________________
_________________________________________)
(Cash/DD(No_______________Date_____________
Name of Bank______________________________) |
FOR OFFICE USE |
| |
| Sri/Smt |
| (Address) |
| |
| is enrolled as a ____________________________________
member of the Indian Red Cross Society, Kerala State Branch / District
Branch / Taluk Branch subject to registration by the Indian Red Cross
Society, National Headquarters, New Delhi. |
| |
| |
| Date : |
| Place : |
Hon. Secretary |
(Seal) |
|
|
