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ROTARACT NIFT-TEA COLLEGE
(Spon: Rotary club of Tirupur North)
R.I. DIST-3202
MEMBERSHIP APPLICATION / RENEWAL FORM - 2019
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* Indicates required question
Theme 2019
Reg. No. / Roll No.
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Your answer
Name
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Your answer
Gender
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Male
Female
Hostel / Day Scholar
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Hostel
Day Scholar
Class
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Your answer
Address
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Your answer
DOB
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MM
/
DD
/
YYYY
Student Mobile Number
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Your answer
Parent Mobile Number
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Your answer
EMail id
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Your answer
Blood Group
Your answer
Hobbies
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Your answer
Additional Skills
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Your answer
Area of Interest to Work
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Club
Community
Youth
Professional
International
Will you take part in 60% of club's social and service activities?
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Yes
No
Are you willing to pay membership and district dues
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Yes
No
Are you existing member or new
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Existing member
New
Aadhar Number
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Your answer
I understand and accept the Principles of Rotaract as expressed in its purpose and objectives and I agree to comply with and be bound by the standard Rotaract Club constitution, Rotaract statement of Policy and Bylaws of the club.
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