MESCO     MODERN EDUCATIONAL SOCIAL & CULTURAL ORGANIZATION (Registered Under the Society Registration Act 1860 & the Bombay Public Trust Act 1950)

Natalwala Building, 110, V.S. Road, Mahim, Mumbai - 400016 Tel No. : 24455365

 

MEMBERSHIP FORM

 

The Executive Secretary,                                                                                No. ________________

Mahim, Mumbai - 400016.

Dear Sir,

I would like to join hands with you in the case of the organization especially to improve the lot of the less privileged member of the Society in the field of Education, Medical assistance & to promote Self Reliance, I give below my particulars

I would like to

1) Enrol As

Ordinary Member for which I remit Rs.100/- p.a.

Life Member for which I remit Rs.2500/-.

Patron Member for which I remit Rs.5000/-

2) Sponsor

The Cost of Educating a child for which I remit Rs.7000/-.

The Cost of One Sewing Machine for which I remit Rs.2500/-.

The Cost of TB Treatment for a patient for 1 year for which I remit Rs.5000/-.

The Cost reconstruction of One Hut For which I remit Rs.7500/-

                                                            Yours Sincerely

 

Date : ______________

Particulars

Name : Mr/Mrs/Miss _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Academic Qualification : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Date Of Birth :_ _ _ _ _ _ _ _ _ _ _ Age :  _ _ _ _ _ Sex:  _ _ _ _ _  Marital Status:  _ _ _ _ _ _ _ _ _ _

Residential Address :  _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Tel No. : _ _ _ _ _ _ _ _ _ _ _ _ _ _

Profession :  _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Tel No : _ _ _ _ _ _ _ _ _ _ _ _ _ _

Whether connected with any other Organization  (Social/Professional) if Yes Specify : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Hobbies & Interests : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Introduced By (Name & Address) : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

FOR OFFICIAL USE

Member Admitted On : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ In Meeting Held :_ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Subscription Receipt No. : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Date : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

President : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Secretary : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _