മെമ്പർഷിപ് ഫോം

KERALA CATHOLIC BIBLE SOCIETY

REF NO. E.R.649/91
PASTORAL ORIENTATION CENTRE
PB No.2251, PALARIVATTOM, KOCHI, KERALA, INDIA. PIN: 682 025,
Phone:
+91 484 280 5897, 280 5722, 280 5815 Fax: +91 484 280 5897
web: http://www.keralabiblesociety.com email: secretary@keralabiblesociety.com

APPLICATION FOR MEMBERSHIP
* indicates required fields
Printable Form

1 Name of the Applicant: *

2 Category:* Individual
Institution
Association
Parish
3 Permanent Address with Pin code: *
4 Phone Number with STD Code:
5 Mobile Number:
6 Email Address:
7 Diocese:*
8 Parish:*
9 Address for correspondence:*
  If An Individual *  
10      Male/Female Male Female
11      Date of birth & Age: (dd/mm/yyyy)
yrs
12      Father/Husband's Name:
13      Your Passport Photo
    
(required if you need an ID card
       with photograph)
  If Not An Individual *  
14     Name of the Authorised Person:
15     Designation:
     
16 Type of Membership:*
View Types of Membership and Fee Structure
Payment Methods
17 Amount and Method of remittance:*

 

 

PLEDGE
I hereby pledge that as I receive the Membership, I will be abiding by the rules and regulations of the Society and work for the benefits of the Society

Signature of the Applicant
(sign by Checking above check box)
  

 

Place:*

 

 

Date:*

 

FOR OFFICE USE

18 Date of Membership:  
19 Receipt No:

Secretary

Chairman

20 Membership Register no: