APPLICATION FORM - SQUASH
4/1 SARAT BOSE ROAD, KOLKATA 700020.
TEL. : +91 33 4017 5555 / 5512.
www.hindusthanclub.com
CIN No. : U91990WB1946GAP013261
HINDUSTHAN CLUB LIMITED
AFFIX
PHOTOGRAPH
INDIVIDUAL
COUPLE
NAME OF THE CANDIDATE(IN CAPITAL LETTER)
BLOOD GROUP (MANDATORY)
MEMBER’S NAME
MEMBERSHIP NO.
MOBILE NO. TEL. NO.
ADDRESS
RELATIONSHIP WITH MEMBER
EMAIL ID
Members are requested to use the facilities HALF AN HOUR.
All Rules and Regulations of the Club for all facilities and all other status as are normal applicable and more specifically applicable to
this organization shall be binding on all Members.
I desire & take YEARLY Membership.
Yearly charges are applicable irrespective of Membership taken in the anytime of the year.
This facilities of Membership ceases on 31st March of EVERY YEAR.
I have read all the Rules & Regulations & agree to abide by the same.
________________________SIGN. OF OFFICE STAFF
________________________SIGN. OF CONVENOR
________________________SIGN. OF CHAIRMAN
________________________SIGN. OF HONY. SECRETARY
[DOCTOR'S CERTIFIED TO PHYSICAL FITNESS IS REQUIRED]
FOR OFFICE USE ONLY
SIGNATURE OF THE CANDIDATE SIGNATURE OF THE MEMBER DATE
DATE OF BIRTH(CERTIFICATE MANDATORY)
CITY STATE COUNTRY PINCODE
RECEIVED RS.
DATE W.E.F
RECEIPT NO.
APPLICATION NO.
PR
INT
ED
BY
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