MEMBERSHIP FORM – Activism Foundation

LIFE MEMBERSHIP FORM

ACTIVISM FOUNDATION FOR SOCIAL RESEARCH & ACTION

One time Subscription: For Students Rs.100/-, For Scholars & Unemployed Rs.500/- and For Others Rs.1000/-
For any difficulty in filling up form contact Joint Secretary @7003556120
For any difficulty in payment contact Treasurer @9051155465

NAME (IN BLOCK LETTER)

Gender

Date Of Birth

CORRESPONDING ADDRESS (POSTAL)

DISCIPLINE STUDIED

INSTITUTION AFFILIATION (PRESENT OR LAST ATTENDED)

CONTACT NUMBER(S) (INCLUDING PHONE & WHATSAPP NO)

EMAIL ID

SUBSCRIPTION PAYMENT OPTION

ONLINE PAYMENT REFERENCE ID (PAY THROUGH SCANNING QR CODE RIGHT BELOW THE FORM OR TO ACTIVISM FOUNDATION, CANARA BANK, A/C NO. 0146101017302, IFSC: CNRB 0000146, KOLKATA RABINDRA SARANI)

CASH PAID TO THE PERSON

PAYMENT/ TRANSACTION DATE

NAME OF THE REFEREE(S)

MEMBERSHIP RULES & DECLARATION

RULES & REGULATIONS OF GENERAL MEMBERS

Members are requested to keep watch official notification in the Facebook group and website
Member should not circulate or share any posts of ACTIVISM apart from the public events
Members should participate in the public events & programs organized by ACTIVISM
Members should not post any abusive, discriminatory, non-secular, regimented and defamatory comments and post to the facebook group or any platform of ACTIVISM
Member should not share any religious or partisan political view in any platform of ACTIVISM

DECLARATION

I, hereby, declare that I join ACTIVISM with my consent & choice and I shall abide by the rules and regulation of ACTIVISM at best of my capacity and knowledge. Thanks