Name : Mr. /Mrs. /Ms.
Father's / Spouse's Name : Mr. /Mrs. /Ms.
Date of birth :	day / month / year
Qualification :
Profession :
Presently working at :
Reasons for becoming an Ami :
Postal Address:
Telephone (Office) :
Telephone (Residence) :
Telephone (Cell) :
Fax No :
E-mail :
Date :	day / month / year
Signature of Applicant
N.B: Please submit this form along with two passport size photographs to the accountant. If you wish to borrow books and cassettes from the library, kindly fill up the adhérent form so as to become an adhérent (Member) of the Resource Centre.
	FOR ADMINISTRATION USE
Ami membership No :		Membership Valid up to :
Receipt No :		Date :
Please note : Application forms can not be submitted through Internet.