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ds Un dh lnL;rk gsrq vkosnuzAPPLICATION FOR THE MEMBERSHIP OF THE CENTRE
MEMBERSHIP CATEGORY
1. ZStudent 2. Teacher 3. Individual Adult 4. Family5.fk{k.k laLFkkInstitutional 6. fuxfer fudk; Corporate House 7. ofjB ukxfjd Senior Citizenfo|kFkh fk{kd OkS;fDrd o;Ld ikfjokfjd lnL;rk oxZ
okfkZd@nkd okfkZd@nkd(Yearly/Decade) (Yearly/Decade)dIk;k tkudkjh LiV v{kjks e Hkjs PLEASE FILL IN THE INFORMATION IN BLOCK LETTERS)
1. Name : _______________________________________________________________2. tUefrfFkDate of Birth : i:k L=hFemale3. Ikrk Address : _______________________________________________________________
_______________________________________________________________njHkkk Tel.No.(dk;kZy; Office) ______________(?kj Resi.)________________ b-ey Email ID : ___________________________ QSDlFax_______________
4. O;olk; Profession : _________________________ 5. kS{kf.kd ;ksX;rkEducational Qualification : _______________________6. ifjokj d lnL;ks dk fooj.kParticulars of Family Members : (only in case of family membership)
1. _______________________________________ Age : ________2. ___________________________________ ___ Age : ________3. ______________________________________ Age : ________
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Male
7. Particulars of Membership Fees (enclosed) :Ik;s Rs.______________ pd@Mh-Mh@dzekadCheque No./DD No._____________________a au@geu lnL;rk d fu;eks dks Ik< fy;k g rFkk mUg ekuu dk opu nrk g@nrh gW@nr gA
I / We have read the rules of this membership and promise to abide by them.
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Date :
Signature of the Applicant
uksV% lnL;rk vkosnu fd, x, ekl ds igys fnu ls ,d@nl okZ gsrq izHkkoh gksxhA lnL;rk kqYd ifjorZuh; gsSAstNote : Membership is effective for one year / 10 years from the 1 of the month of admitting the application.Membership fee is subject to change.
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Effective period of membership : FROM _______________ sTO ________________lnL;rk dekadMembership No._______________ jkfkAmount _________________ikorh la[;kReceipt No.__________________fnukadDate______________________________________[ktkaph d gLrk{kjSign. of Cashier________________________________fo|kFkhZ@fk{kd@OkS;fDrd o;Ld@ikfjokfjd@fk{k.k laLFkk@fuxfer fudk;@ofjB ukxfjd d :Ik e iok nAAdmit as : Student / Teacher / Individual Adult / Family / Institutional / Corporate
lnL;rk dh o/krk dh vof/k l rddoy dk;kZy; d iz;ksx gsrq (FOR OFFICE USE ONLY)
di;k,d QksVksxzkQ;gk fpidk,Please paste
one photographhere
gLrk{k zHkkh l nL;rkdkZeIn-charge Membership Programme
Signature
usg# foKku dsUnzjkVh; foKku l axzgky; i fjkn~l aLdfr ea=ky;] Hkkjr l jdkj
MkW- bZ-ekst sl ekxZ] ojyh] eqacbZ-400018oscl kbZV%www.nehrusciencecentre.gov.in
NEHRU SCIENCE CENTRE(National Council of Science Museums)Ministry of Culture, Govt. of IndiaDr. E. Moses Road, Worli, Mumbai-400 018website:www.nehrusciencecentre.gov.in
7/27/2019 14-7-2012-14-59-12-memberform
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lnL;rk ds fy, lwpukINFORMATION FOR MEMBERSHIP
mnn;Furtherance of scientific temper through hands on educational and science communication activities of the Centre.ik=rkEligibility 5 years and above Indian Citizens only)kqYdFees :lnL;rk kqYd dk;kZy; e lqcg 10-30 ls lk;a 4-30 cts rd tek dj ldr gAMembership Fees can be paid between 10:30 a.m. to 4:30 p.m.
Objective:5 okZ rFkk vf/kd doy Hkkjrh; ukxfjdks gr%dUn dh fk{k.k rFkk foKku lapkj xfrfof/k;ks d ek/;e ls oKkfud nfVdks.k dks c