Application for membership with Bengaluru Sreehatta Sammelani

BENGALURU SREEHATTA SAMMELANI
This form is to provide details for BSS membership. After receiving request BSS Executive Committee (EC) will approve or reject the application. Once approved, members will receive a confirmation email from EC. Members will have to furnish their ID and Address Proof documents as and when required by BSS.

* Required

Membership for the Financial Year

Title *

Name *

Father’s /Husband’s /Guardian’s Name

Nationality *

Date of Birth *

YYYY-MM-DD

Blood Group *

Present postal address *

Country Code *

e.g. In case of Indian Mobile Number, enter 91

Mobile Number *

Email *

Permanent Address *

ID proof type *

ID Proof Number

Address Proof type *

Address Proof Number

[Optional] Were you a member of BSS in past?

If you are past member of BSS, which year did you join BSS? (Need not be exact, it can be off by 1-2 years if you don't remember).

[For New Members] Referred by:

Please provide the name of any BSS member whom you know well and who can introduce you to BSS. This question is only for new members. Not required if you are/were members of BSS.

[For New Members] Any other details you would like to provide

Use this space to tell about yourself and let BSS team know why you would like to part of BSS.

I request the Bengaluru Sreehatta Sammelani to enroll me as a registered member of the association. I undertake to abide by the bye-laws of the association and to actively participate in the accomplishment of aim and objective of the association. I understand BSS will not be held responsible for any actions carried out by me in my personal capacity and also agree to indemnify BSS for any misdeeds from my end that causes disrepute to BSS or any/all of it's member/s. *