Associate Membership

SHRI JAGANNATH MANDIR, TYAGRAJ NAGAR, DELHI

Application Form No

Your Name

Gotra

Father's / Husband's Name

Marital Status

Mobile - Number

Residence Tel No

Your Email

Date of Birth

Designation / Post if working

Present Address

Official / Business AddressOfficial / Business Address

Give name of two persons for reference

Name

Mobile Number

Address

Upload Documents (Aadhaar Card, Pan Card, Voter ID, etc..)

Upload Your Photo (Passport Size)

Terms and Conditions

• I believe in Lord Shri Jagannath and should volunteer to serve Him selflessly and unconditionally
• I understand that for becoming the Associate Membership MEMBER , I have to pay Rs. 1,200 (Rupees one thousand two hundred only) per annum. However i will still try to the best of my capacity to financually support the Mandir.
• The Associate Membership Member is entitled to avail special Puja with their name and Ggotra etc in every Sankranti of the month.

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 a Associate Membership MEMBER

Payment Details
Membership Fee	Rs. 1,200

Associate Membership

SHRI JAGANNATH MANDIR, TYAGRAJ NAGAR, DELHI

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