Young Librarians Association(Reg. No. 01/01/01/21553/10)

86, Sami Manzil, Near Masjid, Haneef Colony, Berasia Road, Karond, Bhopal, (M. P.) Mob. 09827369345, Email: samimanzil1@gmail.com

MEMBERSHIP FORM

Dear Sir,

I am in understanding with the intents of the Young Librarians Association (YLA), and I hereby

apply for admission to Membership. Please accept my vital membership.

Particulars for membership are furnished below: Name: (Surname first) :

Fathers/Husband Name :

Date of Birth :

Academic Qualification ;

Designation :

Department :

Institution/Organization :

E-Mail /Mobile No. :

Office Address :

Home Address :

Date ---------------------- Yours faithfully

Life Membership : Individual : Rs. 1500.00 (Including a copy of the Annual Journal)

Institutional : Rs. 5000.00 (Including a copy of the Annual Journal)

Annual Membership : Individual : Rs. 400.00 (Including a copy of the Annual Journal)

Institutional : Rs. 900.00 (Including a copy of the Annual Journal)

Please find enclosed Cheque/DD No. ……………………………… Drawn on (Name of Bank)… … …

……………………………………Dated ……………………… For Rs. ……………………………………..

Favoring: Young Librarians Association, Bhopal

Money Receipt Received sum of Rs. ………………………… on behalf of Young Librarian Association (YLA) towards the payment of Annual/Life membership for the year …………………………….from Shri/ Mrs./Ms. ……………………………………..

Signature