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Mithila Rajya Nirman Sena-Membership Form

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Mithila Rajya Nirman Sena-Membership Form

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Mithila Rajya Nirman Sena-Membership Form

  1. 1. Mithila Rajya Nirman Sena, Nagar House, Purani Kheda, Dhiraj Nagar, Sector-30, Faridabad Contact: 09213000762, 09136200565, 09910012251 Mithila Rajya Nirman Sena (Membership Form (Ward No./Panchayat: Assembly: Loksabha: ) Name of the proposed member: Father’s Name: Mother’s Name: Address (Mithila): Address (If living out of Mithila): Note: Both addresses are required if living out of Mithila or permanently settled Contact Details Telephone No. (Landline): Mobile Nos.: Email Address: Socila Media’s Ids (1): Socila Media’s Ids (2): References 1. Relative (Not living in your village or town with Name, Address and Mobile No.: 2. Relative (Not living in your village or town with Name, Address and Mobile No.: 3. Relative (Not living in your village or town with Name, Address and Mobile No.: Membership Fee Paid in Cash: Rs. Cheque No.: Rs. Bank Name: Date: (Payer’s Singature) (Receivers Singature with Name and Designation) Membership Fee: 151.00 (Yearly), 1100.00 (Lifetime), You are free to donate as much as you can. For Office Use Only Unique Membership No. Allocated: MRNS/Fbd/2013/ Feedback From the Faridabad District Council:

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