MILESTONE EDUCATION SOCIETY, PEHOWA
No.MSES02/ /……………………
MEMBERSHIP-FORM
Name of the Applicant :……………………………………………….........
Mother’s Name :…………………………………………….............
Father’s Name :………………………………………………………… PHOTO
Date of Birth :………………………………………………………….
Caste & Category :…………………………………………………………
Occupation :……………………………………………….
Educational Qualification :……………………………………………………………………...................
Permanent Address :……………………………………………………………………………………….
...………………………………………………………………………………………
…….………………..………………………………………………………………...
Phone/Mobile No…..……………………Email Id:……………………………..
Declaration:
It is hereby stated that the above information is true and I want to be a member of the Society.
Date:
Place: (Signature)
----------------------------------------------------------------------------------(only for office use)
Date of Joining:
Special Assistance to Society:………………………......................………………………………………………
(Teaching & others activities)
(INCHARGE)
Address: Milestone Education Society , Balmiki Dharmashala, Pehowa (KKR)-136128