Membership Form for Nav Pravah

Membership Form

Nav Pravah

L-11, New RDA Colony, Tikrapara, Raipur-492001 (C.G.) India

To,
Shri Venudhar Routiya
Chief Editor
Nav Pravah
Raipur (C.G.) 492001

Dear Sir/Madam,

Please enrol me as a member for the Nav Pravah. I am sending herewith cash/cheque/bank draft/money order as shown below :-

1. Institutional Annual member Rs. 300/-

2. Institutional life member Rs. 15000/-

3. Individual annual member Rs. 250/-

4. Individual life member Rs. 2500/-

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Educational Qualification----------------------------------------------------
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Published Works (if any)-----------------------------------------------------
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Office----------------------------Resi----------------------------------------
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Yours faithfully : Please send yoursubscription in the name of Nav Pravah only. Outsiders please send Bank Draft/Moneyorder only. Annual postal/courier chargesfor sending journal Rs. 50/- for Raipur and Rs. 100/- for outside Raipur (C.G.).

Note