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For Rs.5000 in favour of
Association of 41 clubs Of India

For Rs.14750 in favour of: 41India

Membership Application Form For New Member

Approval will be processed through email.

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

41 Secretariart office : office41india@gmail.com , secretariat@41india.org , extension@41india.org , president@41india.org & ac1@41india.org

Member's Name

Date of Birth

PAN Number

Date of Anniversary

Office Address

Residential Address

Telephone Number

Mobile Number

Email ID

Present Occupation / Profession

Aadhar Card no/Pan Card no & to be uploaded as per link given

Hobbies

Year of Joining / Year of leaving Round Table

Round Table No. / No. of Years as Round Tabler

Reason for leaving Table.Retirement/Resignation/other Give details

Positions held in RTI, if any

Were you a Sq Leg / Hon Tr - If Yes, Name of Table

Name of the Proposer

Seeking membership of 41 Club

Confirmation of Membership of Chairman of Club No.

Name

Date

Signature of Chairman

Approved by Chairman

Name of the Spouse

Date of Birth

Was she ever LC Member - If Yes, Name of Club

Number of Children

T-Shirt Size (Size Reqd- S/L/XL/XXL/XXXL )

Select Area Chairman

Area Chairman Name

Club

Area

Email ID

Declaration

I, Do hereby declare that the information provided above is true and nothing is false nor anything has been concealed. I understand that any of above information found to be incorrect or misleading shell result in my immediate expulsion from the Assocoation & AOP.

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

For Rs.5000 in favour of
Association of 41 clubs Of India

For Rs.14750 in favour of: 41India

Membership Application Form For New Member

Approval will be processed through email.

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ABOUT US

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For Rs.5000 in favour ofAssociation of 41 clubs Of India

For Rs.14750 in favour of: 41India

Membership Application Form For New Member

Approval will be processed through email.

Quick Links

Our Partners

ABOUT US

GET A FREE QUOTE

For Rs.5000 in favour of
Association of 41 clubs Of India