Office Address: Avenue d'Auderghem 199 Brussels 1040 Tel: +32.2.646 3202 Fax:+32.2.646 3202 Mobile: +32(0)494 721934 +32(0)479 701106 E-mail: firstname.lastname@example.org Website: www.puja-brussels.org. Membership application Form. Membership: Individual/Family.
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Avenue d'Auderghem 199Brussels 1040Tel: +32.2.646 3202Fax:+32.2.646 3202Mobile: +32(0)494 721934 +32(0)479 701106
Membership application Form
For Family only: Number of family members
Proposed by (should be registered member):
Date of Registration:
Registration valid till:
Membership Fees paid:
“I do agree with the objectives of the organization and believe that I also fulfill the criteria of the membership set by the organization. As a member, I will abide with
all directives, regulations and by-laws of the constitution.”
Name & Signature of the applicant:
Signature of the member who proposed:
For official use only
Approved by (at least 3 out of 5 Executive Members): Name and signature
Assigned Membership Number
If refused, mention the proposed date to place the application to the General Assembly.