Membership Transfer Application Form

For Rs.5900 in favour of: 41India

Appliction to be mailed to: – 41india Secretariat and copies to Area Chairman,Extension Convenor & President

Member's Name

Current Club Number / Name

Proposed Transfer Club Number / Name

Office Address

Residential Address

Telephone Number and Whatsapp number

Residential number

Office number

Mobile Number

Email address

Select Area Chairman

Approved by Chairman

Area Chairman Name

Club

Area

Email ID

Declaration by Current Club Chairman / Secretary:

I confirm that I have no objection to above transfer and the member has cleared all his dues to our Club

Declaration by New Club Chairman / Secretary:

I confirm that I have no objection to above transfer and willing to accept the above 41er as a member of our Club

A fellowship of young professionals committed to nation-building through service, friendship, and impactful projects since 1962.