Membership Form

To:
The Secretary
N.S.SOCIETY, Vizianagaram

Dear Sir/Madam,

I(/We) am(/are) interested to serve the Indian poor people through this organization. Please consider me(/us) as member of this organization, my(/our) particulars are entered in the below form and remit specified fee towards my(/our) membership.

Sincerely Yours.

@ Individuals Institutions / Organizations
@ Indians Foreigners Indians Foreigners
Life Member Rs.3000 Not Available Rs.10000 Not Available
One Year General Member Rs.1000 US$ 50 Rs.2000 US$100
One Year Sponsor Member Rs.3000 US$ 100 Rs.6000 US$ 200

Note: Fields marked * are mandatory.  

Select Membership type *
Indians: Foreigners:
Life Member
One year General Member
One year Sponsor Member		 One year General Member
One year Sponsor Member

Full Name: *
Date of Birth / Establishment : * (MM/DD/YYYY)
Gender (Individuals only): Male
Female
Nationality / Country: *
Phone:
Email:
Mailing Address:
Street: *
City: *
State: *
Country: *
Zip / PIN: *
Activities / Interests:
Member Fee Payment: * Cash
Check
Demand Draft
Credit Card

Note:
Cash, Check, Demand Draft can be sent/drawn in favor of
National Socio Economic Society, payable at Vizianagaram
Address: 8-18-50 Sri Rama Colony, Vizianagaram, AP-535003, India
Credit Card payments can be made through PayPal secure payment system (click on "Make a Donation" button below).



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