meom³elee-He$e MEMBERSHIP-FORM

cenemeef®eJe /Hon. General Secretary

m¬eÀervejeFìme& SmeesefmeSµeve Screenwriters Association

Mumbai - 400 053.

cewQ SmeesefmeSMeve keÀe meom³e yeveves kesÀ efueS efveJesove keÀj jne / jner ntB ~ cesjer J³eefkeÌleiele peevekeÀejer Fme ÒekeÀej nw ~ I request you to enroll me as a Member of the Association, particulars regarding me are as follows -

veece / Name

efHelee /ceelee keÀe veece Father/Mother’s Name

Gce´ /Age pevce leejerKe /Date of Birth

Mew#eefCekeÀ ³eesi³elee /Educational Qualification

efjueer]pe ngF& ef]HeÀuce/meerefj³eue/Dee@ef[³ees keÀ@mesì/DeueyeceReleased Picture/Serial/Audio Cassestte/Album

efjueer]pe keÀe Je

Sign. of the receiver

efìHHeCeer

Remarks

Chq. No. Date:

Bank Name

Branch

keÀe³ee&ue³e kesÀ Ghe³eesie kesÀ efueS / For Office Use Only

efvecveefueefKele jeefMe ®eskeÀ Üeje /vekeÀo ÒeeHle keÀer / Received the money as below:

DeeJesove He$e / Application Form

ÒeJesMe MegukeÀ / Admission Fee

Jeeef