membership form of patrone members of yla
TRANSCRIPT
Young Librarian Association(Reg. No. 01/01/01/21553/10)
86, Sami Manzil, Near Masjid, Haneef Colony, Berasia Road, Karond, Bhopal, (M. P.) Mob. 09827369345, Email: [email protected]
MEMBERSHIP FORMPatron Member
Dear Sir,
I am in understanding with the intents of the Young Librarian Association (YLA), and I hereby
apply for admission to Patron Membership. Please accept my vital membership.
Particulars for membership are furnished below: Name: (Surname first) :
Fathers/Husband Name :
Date of Birth :
Academic Qualification ;
Designation :
Department :
Institution/Organization :
E-Mail /Mobile No. :
Office Address :
Home Address :
Date ---------------------- Yours faithfully
Membership fee : 5000.00 (Patron Member)
Please find enclosed Cheque/DD No. ……………………………… Drawn on (Name of Bank)… … …
……………………………………Dated ……………………… For Rs. ……………………………………..
Favoring: Young Librarian Association, Bhopal
Money Receipt
Received sum of Rs. …… ………. on behalf of Young Librarian Association (YLA) towards the payment of Patron membership from Shri/ Mrs./Ms. ……………………………………..
Signature