Inygma - BNYS Application Form

Fellow/Associate Membership Form

Name of the Applicant:

Name of Father/Husband:

Date of Birth:

Qualification Details:

Year of Completion:

Name of the College:

Details of Registration:

Contact Address:

Mobile Number:

Email ID:

Gender:
Male Female

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I Promise to abide by the rules and regulations laid down by the association genuine. I hereby assure that the information furnished above is authentic & genuine to the best of my knowledge. I promise to stand by the activities undertaken by the association and assure the best of co-operation.

Signature of Applicant:

Date: