MEMBERSHIP APPLICATION FORM

Name :

Designation :

Date of Birth :

Organization :

Correspondence Address :

Land Line Number :

Email :

Mobile Number :

(Please tick the appropriate)

Membership Type : Life Time

Membership Category : Individual / Institutional

Membership Fees :

Life Membership:

Individual:

a. Life membership (Professionals) : INR 4,000/- b. Life membership (Teachers) : INR 3,000/-

Institutional : INR 5,000/- ( For a period of 10 Years)

Payment Details: DD/Cheque in favour of: MTC Global Trust, Payable at Bangalore

Passport Photo

DD/Cheque No.

Date Amount Bank Name & Branch

OR

You may send the fees electronically with a confirmation mail to president@mtcglobal.org to the following a/c for your convenience:

Account Name:  MTC Global Trust Account Number    : 6063000100011431Account Type : Savings A/C Bank Name     :   PUNJAB NATIONAL BANK IFSC Code        :   PUNB0606300 Branch       :   Mahadevpura Branch, Bangalore-560048, India

Name [Digital Signature, if possible]

[GO GREEN: AS A POLICY MATTER, MTCIANS ARE ENCOURAGED TO SEND THE SOFT-COPY OF THE MEMBERSHIP FORM AND ALSO MEMBERSHIP FEES THROUGH NEFT / DEPOST IN LOCAL PNB ONLY]

If you are not able to do NEFT/ Deposit it the case in local branch then please send the cheque/DD in favour of ‘ MTC Global’ and send it to the following address:

ADDRESS

PROF. BHOLANATH DUTTA3rd Floor, Room Number- 306, R. Jayappa Building, Above STS Bakery,Near Vinayaka Theatre, Lady Velankanni School Road, Varthur, Bangalore – 560 087Cell- 97323 18178/ 9880077414