This membership form collects personal information such as name, date of birth, occupation, address, contact details, and illness from individuals interested in joining Sjögren's India. It asks patients to check which illness they have from a list of autoimmune diseases. A membership fee of Rs. 300 can be paid by demand draft or cheque made out to Sjögren's India and sent to the provided address and contact details in Ahmedabad, Gujarat. Additional contributions to support the organization are also accepted.

1. Membership Form
Name: Ms./Mrs./Mr.
Date of Birth: (DD/MM/YY) Age (in years):
Occupation:
Patient/Family Member/Volunteer/Healthcare Professional/other
(specify)
Patients please Tick mark your illness:
Sjögren's syndrome (SS)/ Lupus (SLE)/ Scleroderma/ Myositis/ RA with SS
Postal Address:
City:
Taluka:
District:
State:
Pin code:
Tel: (R) (O) (M)
E‐mail:
Signature: Date:
Sjögren’s India Membership Fee of Rs. 300/- may be sent by DD or cheque drawn in favour of
Sjögren’s India. Please write your name and city on the back of the cheque and send to:
701, Vatsaraj, Opp. Shraddha School, Jodhpur Gam Road, Ahmedabad‐380015, Gujarat.
Tel +91–79 ‐26922254
Sjögren’s India is a voluntary initiative managed by patients. Additional Contributions
to support our cause may be sent by separate cheque/DD in favour of ‘Sjögren’s India’
to the above address