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Membership Application Form  
 


Please fill in the form and return it, along with a recent stamp-size photograph, to The Director, Alliance Française du Bengale, Khaleel Munzil, 217 A.J.C. Bose Road, Kolkata 700017,

Tel: 2281 5538/2281 5198
Fax: 2281 5600

Date :

Surname : Miss Mrs. Mr.
       
Name :    
       
Address :  
       
Date of birth : day / month / year
       
Place of birth :    
       
Nationality :    
       
Residential address :    
       
Occupation :    
 
Educational qualifications :
       
Why do you want to join Alliance Française du Bengale ?
       
Telephone : Fax :
       
Residential address :    
 
Telephone : Fax :      
       
E-mail :    
       
I hereby certify the accuracy of the above details and acknowledge the receipt of the rules and regulations of Alliance Française du Bengale.:
   
    Signature of member  
       
       
       
    Signature of Director  
       
Proposed by two active members :    
  Name Signature  
1  
2  
       
Receipt No. Date Amount Valid upto
 
 
     

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