Membership Application Form

Name :

Date of Birth :

Father’s Name :

Address in Kerala :

Society in which residing or having Flat :

Present Address for Communication :

Residence Number :

Mobile Number :

E-Mail ID :

Occupation/Profession /Qualification (With Name of company and office phone number) :

Blood Group :

Family Details (Spouse and Children)
(Pls Provide Name, Relation, DOB, Profession/Class in which studying etc.)

Whether applicant can devote time for MAGNa Work, If Yes in what specific field or activity :

Areas of Interests :

Mode of Payment :

I have read the Rules and Regulations of the Association and I hereby solemnly undertake to abide by the same. The Membership fee is enclosed.