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APPLICATION FORM - SQUASH 4/1 SARAT BOSE ROAD, KOLKATA 700020. TEL. : +91 33 4017 5555 / 5512. [email protected] www.hindusthanclub.com CIN No. : U91990WB1946GAP013261 HINDUSTHAN CLUB LIMITED AFFIX PHOTOGRAPH INDIVIDUAL COUPLE NAME OF THE CANDIDATE (IN CAPITAL LETTER) BLOOD GROUP (MANDATORY) MEMBER’S NAME MEMBERSHIP NO. MOBILE NO. TEL. NO. ADDRESS RELATIONSHIP WITH MEMBER EMAIL ID 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. ________________________ SIGN. OF OFFICE STAFF ________________________ SIGN. OF CONVENOR ________________________ SIGN. OF CHAIRMAN ________________________ SIGN. OF HONY. SECRETARY [DOCTOR'S CERTIFIED TO PHYSICAL FITNESS IS REQUIRED] FOR OFFICE USE ONLY SIGNATURE OF THE CANDIDATE SIGNATURE OF THE MEMBER DATE DATE OF BIRTH (CERTIFICATE MANDATORY) CITY STATE COUNTRY PINCODE RECEIVED RS. DATE W.E.F RECEIPT NO. APPLICATION NO. PRINTED BY : www.abhishekcolors.com - 9830005273
