Libraryassociationmangalore

Membership Application Form

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APPLICATION FORM

To,

The Secretary,

Dakshina Kannada & Kodagu Library Association (Regd)

c/o Senior Librarian,

St. Agnes College, Bendore,

Mangalore-575003

Email: bk.vishala@gmail.com

Dear Sir/Madam,

Please enroll me as a Patron/ Life member of the Association. I am enclosing a Cheque / Demand Draft No……………………… dated: ……………………………. drawn on ………………………….Bank for Rs.250/ being the requisite membership fee. My particulars are as follows. (Use only capital letters).

(Note: cheque should be drawn in favour of Dakshina Kannada and Kodagu Library Association (R) Udupi)

Please fill this form and submit

	Column 1
Row 1 NAME
Row 2 DESIGNATION
Row 3 QUALIFICATION
Row 4 OFFICE ADDRESS
Row 5 RESIDENTIAL ADDRESS
Row 6 OFFICE PHONE NO.
Row 7 RESIDENCE NO.
Row 8 MOBILE NO.
Row 9 E-MAIL ID 1
Row 10 E-MAIL ID2

Date:

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