Application Form No *
Your Name *
Father's / Husband's Name *
Marital Status * MarriedUnmarried
Mobile - Number *
Residence Tel No
Your Email *
Date of Birth *
Present Address *
Official / Business AddressOfficial / Business Address *
Designation / Post if working *
Give name of two persons for reference
Reference 1
Reference 2
Name
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Terms and Conditions
• The Honorary Member should believe in Lord Shri Jagannath and should volunteer to serve Him selflessly and unconditionally
• The Honoray Member should undertake to pay his / her annual membership frees as determined by the Working Committee of the Mandir- society from time to time ( present fees being @Rs. 1500/- per annum) ontime inorder to continue his / her membership. The Honorary Member should financially support the Mandir
• The Honoray Memebr is entitled to some facilities like Membership Certificate, T- Shirt ( for the promotion of the Mandir) and I-Card etc as determined by the Working Committee for better discharge of his/ her voluntary services . The Associate Member is entitled to attend in all meetings of General Body but does not have right to vote / contest.
Declarations I, Name , declare that, I have read all the above mentioned terms & conditions and I hereby undertake to abide by the same Rules and Regulations of the Mandir - Society. I further request that my membership may be kindly accepted and I may be given an oppertunity to serve at the Feet of Lord Jagannath as an HONORARY MEMBER.
Membership Fee = ₹ 1500/-
