squash application form - hindusthan club limited

HINDUSTHAN CLUB LIMITED
4/1 SARAT BOSE ROAD, KOLKATA 700020.
TEL. : +91 33 4017 5555 / 5512.
[email protected]
www.hindusthanclub.com
CIN No. : U91990WB1946GAP013261
APPLICATION FORM - SQUASH
RECEIVED RS.
AFFIX
PHOTOGRAPH
INDIVIDUAL
RECEIPT NO.
COUPLE
DATE
W.E.F
APPLICATION NO.
NAME OF THE CANDIDATE
(IN CAPITAL LETTER)
DATE OF BIRTH
BLOOD GROUP (MANDATORY)
(CERTIFICATE MANDATORY)
MEMBER’S NAME
MEMBERSHIP NO.
RELATIONSHIP WITH MEMBER
ADDRESS
CITY
STATE
COUNTRY
MOBILE NO.
PINCODE
TEL. NO.
 Members are requested to use the facilities HALF AN HOUR.
 All Rules and Regulations of the Club for all facilities and all other status as are normal applicable and more specifically applicable to
this organization shall be binding on all Members.
 I desire & take YEARLY Membership.
 Yearly charges are applicable irrespective of Membership taken in the anytime of the year.
 This facilities of Membership ceases on 31st March of EVERY YEAR.
 I have read all the Rules & Regulations & agree to abide by the same.
SIGNATURE OF THE CANDIDATE
SIGNATURE OF THE MEMBER
DATE
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EMAIL ID
[DOCTOR'S CERTIFIED TO PHYSICAL FITNESS IS REQUIRED]
FOR OFFICE USE ONLY
________________________
SIGN. OF OFFICE STAFF
________________________
SIGN. OF CONVENOR
________________________
SIGN. OF CHAIRMAN
________________________
SIGN. OF HONY. SECRETARY