Rajyoga Education & Research FoundationRegistered as Society under the provision of Societies Registration Act, XXI of 1860 at

Pandav Bhawan, 25, New Rohtak Road, Karol Bagh, New Delhi-110 005. Tel: 011-23680496

Life Membership Application Form-Medical Wing

Date: ......../........./20.....

The President

Rajyoga Educa�on & Research Founda�on

Pandav Bhawan

Mount Abu 307 501.

I hereby apply to be a member of Rajyoga Educa�on & Research Founda�on and pay herewith ₹25/- as entrance fee alongwith ₹2000/- as Life Membership Subscrip�on.

Kindly treat my entrance fee and Life membership subscrip�on as my voluntary contribu�on to the corpus of your Society. I have read the rules and regula�ons of the Rajyoga Educa�on & Research Founda�on and agree to abide by them and accept disciplinary jurisdic�on of the President or any cons�tu�onal authority.

I further cer�fy that I am a regular student/member of PBKIVV Centre at ..................................................................... Zone............................................ since last ............ years and observe all the principles and disciplines.

Following are my detailed par�culars:

1. Full Name : ................................................................................................................. Date of Birth : ...........................

2. Full Address : .................................................................................................................................................................

City : ........................................................................... District : .....................................................................

State : ......................................................................... Country : ................................... Pin : .......................

3. Contact Details:

Land Line: .................................................. Mobile : ................................................

WhatsApp : ................................................

E-mail : .................................................................................................................................................................

4. Qualifica�on : ..................................................................... Designa�on :..............................................................

Organisa�on :................................................................................................................................................................

5. Amount : ₹........................... Amount in words : .........................................................................................................

Mode of Payment: Cash Cheque DD CBS NEFT RTGS Ref. No.: ........................... Date :.......................

Bank : ............................................................................................ Branch :......................................................................

............................................................................ .................................................................. Signature of BK Centre In-Charge/Wing Co-ordinator Signature of the Applicant

For Office Use Only

Receipt Number: .............................. Membership Number: ............................. Membership Date: .............................

Note: Cheque or DD is accepted in favour of 'Rajyoga Educa�on and Research Founda�on'. Email us on medicalwing@bkivv.org for any assistance.