Registered under the Societies Registration Act ( XXI of 1860 & as Amended by Punjab Amendment Act 1957) Registration No. 1797 V.P.O. Takarla Tehsil Balachaur District S.B.S.Nagar Punjab-144521 Phone: 91-9463613708 Email:[email protected] MEMBERSHIP/DONATION FORM Ms/Mrs/Mr/Dr___________________________________________________________ Address________________________________________________________________ ________________Pin Code______________ Phone (Home) _____________________ Mobile____________________Email_________________________________________ Occupation_________________________Qualification__________________________ Date of Birth (dd/mm/yy) __________________________________________________ Special Areas of Interest___________________________________________________ Membership fee: Annual ₹ 1000.00 Life ₹ 10,000.00 Annual fees are based on financial year (i.e. valid until March 31st) DONATION/PLEDGE: A one-time donation, in the amount of ₹_____________________________________ A repeating donation, in the amount of ₹_______________________________per year (Khwahish Sewa Society “KHASS” is a NGO which solely depends on your generous support) Mode of payment: Cash/Cheque/DD No______________________________________ (Cheques/DD payable to “Khwahish Sewa Society”) I, hereby agree to abide by the rules of the “KHASS” as set out in the by-Laws (please ask copy from the secretary) Date _______________________ Signature___________________________ Office use only: Date Received Cheque Number Welcome/Msg Email Database Thank you letter