Membership Form
BORI DEVELOPMENT TRUST
House no. 197, Durganagar, Bori, Goa 403401
Application to become lifetime member
To the Settlor
I______________________ wish to be a lifetime member of Bori Development Trust, as I am :
□ Born in Bori
□ Present resident of Bori
□ Ancestoral origin from Bori
□ Devotee of Navdurga temple
My details are as follows:
Full Name______________________________ Father/Husband of ____________________________________
Age ________ Marital Status___________________
Full Address_____________________________________________________________________
Tel: ____________________ Mobile:____________________ Email:________________________________
I shall abide to the rules and regulations of Bori Development Trust which I have read and understood.
Please accept Rs 1000 towards Life Membership Registration Fees vide cash/DD/Cheque no. _______ bank ____________________
Yours faithfully,
__________________________________________________________________________________________________________________________________________________________
FOR OFFICIAL USE ONLY:
Mr./Mrs/Ms ____________________________________________________ is accepted as Lifetime Member. The registration fees received under receipt no_____________
Dtd.__________________
SETTLOR