JOIN US

Respected Sir/Madam                              
Please  enroll me as a Member in SIMPATHY                                      

MEMBERSHIP FORM

Name……………………………...........................................………………..

Father’s/Husband Name…………................................................................………….

Date of Birth…………...................................................................……………….....

Residence Address…….…………………….…………………….……............................

...................................................................................................................................................................

Office Address……................................……………………………………………......

…………...................................................................………………............................

Designation…………................................Qualification…………..................………

Identity Card No………................……….Passport No…………………....................

Driving License No………......…………….Voter I.D.No……......................……….

Telephone No……………………........……..Fax. No……………….............................

Email…………………………………………,................................................................

PERSONAL DETAILS

Type of Vehicle Using…………………....…………………........………………….....

Registration No of Vehicle…...........................................................…………... 

Height………................………Weight…………………Blood Group…………………..

Disease………….............................................................………………………………

Allergies…………………...............................Eye-sight………..............................

In case of Emergency call to…………................……………………………………

The above all information’s are correct and right in my knowledge, I am neither involving in any kind of illegal Activities nor having any kind of illegal cases in court. I am accepting all social duties and Social responsibilities as a member of SIMPATHY.

INSTRUCTIONS

1. Members must be renewing his/her Membership in time and get Fresh Identity Card.

2. Members will entitle to take Accidental Insurance for worth of Rs 1 lack by Simpathy.

3. Members will participate in all Activities/Program/Social responsibilities done by Society.

4. Members will award by Certificate/Memento/Shield/Gold & Silver Medal for his/her Social Activities.

5. Members will Contact to Society for any kind of help like Legal/ Medical /Social /Domestic Violence etc.

6. Active Members (Life Time) will be a Board of Members of Simpathy and they entitle to give advice and suggestion time to time for development

                                                                                                                         Signature of Candidate   

 

Place……………..                                      Date:………….……