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Membership Card Request Form: Mensa India Delhi

This document is a membership card request form for Mensa India Delhi/NCR. It requests the applicant's first, middle, and last name in capital letters, as well as two stamped size photographs with the applicant's name written on the back. The applicant must pay a 30 rupee fee and circle whether they are applying for a life or annual membership. The completed form and any supporting documents or fees should be mailed to the listed address.

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David Turner
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276 views

Membership Card Request Form: Mensa India Delhi

This document is a membership card request form for Mensa India Delhi/NCR. It requests the applicant's first, middle, and last name in capital letters, as well as two stamped size photographs with the applicant's name written on the back. The applicant must pay a 30 rupee fee and circle whether they are applying for a life or annual membership. The completed form and any supporting documents or fees should be mailed to the listed address.

Uploaded by

David Turner
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Membership Card Request Form

mensa india delhi,


c/o Mr. Kishore Asthana Convener, Mensa Delhi/NCR D-173, Sushant Lok 1 (Opposite Park Plaza Hotel) Gurgaon 122002, Haryana
Tel: 9818148602

Please pay the Membership Card fee of Rs. 30 to your chapter head.

Please write clearly in CAPITAL letters:

First name

Middle name, if any

Last name

Please attach two (2) STAMP SIZE photographs ( with your name written behind each photo in Capital letters). Applied for Life / Annual Membership (Please circle the relevant duration) Please do not write below this line: FOR OFFICE USE ONLY: Membership Number (8-digits): ______________________________ Valid Upto : LIFE _________ ________________ Cut here and send only the TOP part
Please mail this completed form along with the membership application form to:

Mensa India (Delhi/NCR),


c/o Mr. Kishore Asthana
Convener, Mensa Delhi/NCR D-173, Sushant Lok 1 (Opposite Park Plaza Hotel) Gurgaon 122002, Haryana tel: 9818148602 / em: [email protected]

Membership application form / Membership Card Request Form must be complete in all respects. All necessary supporting documents/photographs and fees must accompany the form for these to become operational.

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