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APPLICATION FOR ANNUAL MEMBERSHIP - Delhi Press Club
PERSONAL DETAILS :
Name of the Applicant Mr/Mrs./Miss :
Father's/Mother's/Husband's Name :
Age & Date of Birth:
E-mail I.D. :
Complete Postal Address (with PIN Code) ;
Office / Work Place Address :
Residential Address :
Names of Family Members :
Educational Qualification :
Professional Degree / Diploma etc. (if any) :
Any other Qualification/ Specialization :
Experience (in years) in the field :
PROFESSIONAL DETAILS :
(If a freelancer/Self employed etc) :
Monthly Income :
Period of association with :
Present organization :
Name of organizations Served Previously :
Please give two references with designation, phone nos. & complete address (Preferably media persons/ Govt. Servants/Employed with reputed organizations etc).
New Delhi , Dated ........2015 Signature of Applicant
- Please attach your recent passport sized photograph along with this form.