Membership Form

GOA ECONOMIC ASSOCIATION (GEA)

(Membership Form)

To,

The General Secretary,

Goa Economic Association

Dear Sir,

I request you to kindly enroll me as Life/ Ordinary/ Institutional Member of the Goa Economic Association. The membership fee of Rs….........................is attached herewith by Cash / Cheque / Demand Draft No. .........................................................Dated.........................................

I am giving below my full particulars.

Name in Full              :..........................................................................................................................................

Qualifications             :..........................................................................................................................................

Designation                : .........................................................................................................................................

Address

Office                   :       ..........................................................................................................................................................

                   

                   ………………………………………………………………………………………………………

           E-mail: …………………………………….................................Phone No.:……………………..

     Residence:

..........................................................................................................................................................

………………………………………………………………………………………………………………

E-mail:…………………………………………………………...Phone No.:………………………

Please acknowledge the receipt of the amount.                            Receipt No: ………………….

Date..........................................

Yours faithfully,

(Name and Signature):