Delhi Press Club, New Delhi, India DELHI PRESS CLUB
NEW DELHI, INDIA
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APPLICATION FOR ANNUAL MEMBERSHIP - Delhi Press Club

PERSONAL DETAILS :

Name of the Applicant Mr/Mrs./Miss :

Father's/Mother's/Husband's Name :

Age & Date of Birth:

Tel./Mobile No.:

E-mail I.D. :

Complete Postal Address (with PIN Code) ;

Office / Work Place Address :

Residential Address :

Names of Family Members :

Qualification :

Educational Qualification :

Professional Degree / Diploma etc. (if any) :

Any other Qualification/ Specialization :

Experience (in years) in the field :

PROFESSIONAL DETAILS :

Organization :

(If a freelancer/Self employed etc) :

Designation :

Department :

Monthly Income :

Period of association with :

Present organization :

Name of organizations Served Previously :

REFERENCES :

Please give two references with designation, phone nos. & complete address (Preferably media persons/ Govt. Servants/Employed with reputed organizations etc).

1.

2.

New Delhi , Dated .2010                Signature of Applicant

- Please attach your recent passport sized photograph along with this form.
- Filled-up application form may be submitted at our Dak Counter at Connaught Place or email us at applymembership@gmail.com. Helpline: (0)9310695196
 

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