Subscription - The Bengalee Association, Bangalore

NB : The mandatory fields are in Red

Identity:

Title:

Gender: Unspecified Man Woman

First Name:

Middle Name:

Last Name:

Nickname:

Birth Date: (dd/mm/yyyy format)

Birthplace:

Profession:

Marital Status:

Anniversary Date: (dd/mm/yyyy format)

Spouse Name:

Father's Name:

Blood Group:

Spouse's Blood Group:

Contact Information:

Address:
Address Line 2:

City:

Zip Code:

Country:

Phone:

Mobile Phone:

E-Mail:

Communication Preference:

System-related data:

Be Visible in the Members List: If you check this box (And if you are up to date with your contributions), your full name, website address and other information will be publicly visible on the members list.
If you've uploaded a photo, it will be displayed.
Note that Administrators can disable public pages. This setting will have no effect in that case.

Username: (at least 2 characters)

Password: Password Image Please type the password shown in the image in the field.

Other Information:

Additional Fields:

Areas of Interest

Enter up to 5 occurences.

Please take a printout of the form after saving, and submit it in the Association Office along with the required fees and documents. Details below.
Fees for new members. Registration Fee (One Time): Rs. 100/- Library Fee (One Time): Rs. 100/- Monthly Fee (till end of calendar year): Rs. 60/- pm
Documents required to be submitted with form. Two passport sized photographs One Government Address Proof