DHOLA-RI-DHANI


Form for Membership
1. Privilege/Permanent Card	Rs. 12,500/-
2.Executive Card	Rs. 6,000/-
3.Sr. Citizen Card(Above 65 Years)	Rs. 5,000/-
4.One Year Membership Card	Rs. 1000/-
Please select one of the membership: Privilege/Permanent Card Transferable/Executive Card Sr. Citizen Card(Above 65 Years) One Year Membership Card
First Name
Last Name
Date of Birth:	//
Designation
Spouse's Name
Children's Name:
1.
2.
3.
4.
Residence Address:
Office Address:
Phone Nos.:
Residence
Office
Pager No
Cell No
E-mail Address :
All Correspondence should be sent to Residence Office
Wedding Anniversary
Profession Occupation:
1. Education Qualification
2. Profession and Designation

Corporate Office: 714,CTC, Park lane, Secunderabad-500003 Telephone: 91-40-27721586,55310549