RBU – NSS UNIT

MEMBERSHIP
Registration Form

A: PERSONAL DETAILS(in capital letters)

Name: Mr/Ms: __________________________________________

Father’s Name: ________________________________________

Name of the NSS Prog Officer:___________________________

Date of birth: ____________Male / Female: ___________________

Religion__________________

Aadhar Card No._______________________

Class Studying in: _____________Whether SC/ST/OBC/GEN: ________

University: _____________________State/U.T.: ______________________

B: CONTACT DETAILS

College /Institution Name & Address: Residential/ Permanent Address:

Telephone No: Telephone No:

Fax No: Mobile No:

E mail ID:
E mail ID:

C: OTHER DETAILS
(i) Food habit: Veg / Non-Veg: __________

(ii) I herby declare that the above mentioned information is true to make knowledge. I will follow all the rules and regulations of event.

(iii) NSS Enrolment Year: _______________

(iv) Under NSS unit of RBIEBT, I will work for the welfare of the society and participate in at least 50% of the events organized by UNIT.

Signature of the NSS Volunteer Signature of the NSS Programme Officer