LENSFED

Associate Membership Form

 
 

(2.5 x 3.5 cm, 300 dpi Resolution, jpeg file only)

 Male     Female
 
 
  Yes      No
  Married     Unmarried

DECLARATION

I, hereby declare that the particulars furnished above are true and correct.

Date : Signature *

Unit Secretary

Taluk/Area Secretary

District Secretary

Note:Take print out and submit the application to unit sercretary along with admission fee Rs 100/-.
 
 

ONLINE MEMBERSHIP APPLICATION FORM

Personal Details

District
your image
Taluk/Area
Unit
Name
Residential Address
House Name
Place
Post Office
City/Town
Land Mark
Pin
Land Phone
Official Address /Address for Communication
Office Name
Place
Post Office
City/Town
Land Mark
Pin
Land Phone
Mobile
E-mail
DOB
Age
Blood Group
Sex
Academic Qualifications
Technical Qualifications
Membership in Other Technical
Year of Passing
Name of firm/firms which you practice with
Peroid of practice
Whether applied for licence
If yes, which RJD with date
Marital Status
Other Professional activities/Business
Hobby
 
DECLARATION
I    , hereby declare that the particulars furnished above are true and correct.
 
Yours Faithfully,
 
 
Place :
Date   : 09-12-2019
 
Unit Secretary Taluk Secretary District Secretary