Membership form
HOPE & Animal Trust
 
No.
Membership Code :
Receipt No.

(To be filled by the office)
To,
The Secretary General,
HOPE & Animal Trust, 		   
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Sir,
I S/o- W/o-D/o do hereby request you to grant me membership in the following category : (Tick whichever is applicable)
        Founder Member
        Patron Member
        Life Member
        Dignified Member
        Respected Member
        General Member
        Other
     
   Member's Particulars
1.
Name
  
2.
Sex
  
Male Female
3.
Father's /Husband's Name
  
4.
Age
  
5.
D.O.B
  
6.
Qualification
  
7.
Occupation
  
8.
Permanent Address
  
9.
Address for Correspondence
  
10.
Phone No. Residence with S.T.D.
  
-
11.
Phone No. Office with S.T.D
  
-
12.
Mobile No.
  
13.
Email
  
14.
PAN No. (With designation of Officer-Circle/Ward/Place)
  
Declaration
 
I have read all the rules and regulations regarding the membership of HOPE & Animal Trust elaborated after the application form and objectives of HOPE & Animal Trust attached with the application form. I shall abide by all the concerned rules and regulations. In the event of violation of concerned rules and regulations under any circumstances by me, the HOPE & Animal Trust is free to take any disciplinary action against me without assigning any reason thereof and I shall be entirely responsible for it. I now request you to enroll me as a member as per rules and regulations of the HOPE & Animal Trust.

Signature of Applicant