LENSFED

Online Membership Form

 
 

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

 Male     Female
  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 1000/-.
 
 

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
Category of license obtained
License No
Date of Issue
Next Renewal 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