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ds Un dh lnL;rk gsrq vkosnuzAPPLICATION FOR THE MEMBERSHIP OF
THE CENTRE
MEMBERSHIP CATEGORY
1. ZStudent 2. Teacher 3. Individual Adult 4. Family5.fk{k.k
laLFkkInstitutional 6. fuxfer fudk; Corporate House 7. ofjB ukxfjd
Senior Citizenfo|kFkh fk{kd OkS;fDrd o;Ld ikfjokfjd lnL;rk oxZ
okfkZd@nkd okfkZd@nkd(Yearly/Decade) (Yearly/Decade)dIk;k
tkudkjh LiV v{kjks e Hkjs PLEASE FILL IN THE INFORMATION IN BLOCK
LETTERS)
1. Name :
_______________________________________________________________2.
tUefrfFkDate of Birth : i:k L=hFemale3. Ikrk Address :
_______________________________________________________________
_______________________________________________________________njHkkk
Tel.No.(dk;kZy; Office) ______________(?kj Resi.)________________
b-ey Email ID : ___________________________
QSDlFax_______________
4. O;olk; Profession : _________________________ 5. kS{kf.kd
;ksX;rkEducational Qualification : _______________________6. ifjokj
d lnL;ks dk fooj.kParticulars of Family Members : (only in case of
family membership)
1. _______________________________________ Age : ________2.
___________________________________ ___ Age : ________3.
______________________________________ Age : ________
uke
Male
7. Particulars of Membership Fees (enclosed) :Ik;s
Rs.______________ pd@Mh-Mh@dzekadCheque No./DD
No._____________________a au@geu lnL;rk d fu;eks dks Ik< fy;k g
rFkk mUg ekuu dk opu nrk g@nrh gW@nr gA
I / We have read the rules of this membership and promise to
abide by them.
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Date :
Signature of the Applicant
uksV% lnL;rk vkosnu fd, x, ekl ds igys fnu ls ,d@nl okZ gsrq
izHkkoh gksxhA lnL;rk kqYd ifjorZuh; gsSAstNote : Membership is
effective for one year / 10 years from the 1 of the month of
admitting the application.Membership fee is subject to change.
--------------------------------------------------------------------------------------------------------------------------------------
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Effective period of membership : FROM _______________ sTO
________________lnL;rk dekadMembership No._______________
jkfkAmount _________________ikorh la[;kReceipt
No.__________________fnukadDate______________________________________[ktkaph
d gLrk{kjSign. of
Cashier________________________________fo|kFkhZ@fk{kd@OkS;fDrd
o;Ld@ikfjokfjd@fk{k.k laLFkk@fuxfer fudk;@ofjB ukxfjd d :Ik e iok
nAAdmit as : Student / Teacher / Individual Adult / Family /
Institutional / Corporate
lnL;rk dh o/krk dh vof/k l rddoy dk;kZy; d iz;ksx gsrq (FOR
OFFICE USE ONLY)
di;k,d QksVksxzkQ;gk fpidk,Please paste
one photographhere
gLrk{k zHkkh l nL;rkdkZeIn-charge Membership Programme
Signature
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kbZV%www.nehrusciencecentre.gov.in
NEHRU SCIENCE CENTRE(National Council of Science
Museums)Ministry of Culture, Govt. of IndiaDr. E. Moses Road,
Worli, Mumbai-400 018website:www.nehrusciencecentre.gov.in
