Association of Engineers Membership Application

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ASSOCIATION OF ENGINEERS, KERALA

ROADS DIVISION CAMPUS, PMG, THIRUVANTHAPURAM-690 033


APPLICATION FOR LIFE MEMBERSHIP 1. Name (In Block Letters) 2. Permanent Address : :

Mobile Email Address 3. Date of Birth 4. Office Address with Tel.No.

: : : :

5. Sex 6. District

: :

DECLARATION I,............................................................................................................... here by undertake to abide by the Bye-laws and regulations of the Association of Engineers Kerala. Place Date Signature of Applicant Name Recommendation of the District Centre

District Secretary Name of District Receipt No. Secretary Life Membership No. President

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