Nature Club Form - SECR




SOCIETY FOR ENVIRONMENT CONSERVATION AND RESEARCH
Nature Club Membership Registration Form
For Schools / Colleges / Institutes / Volunteer organizations / Public groups

Urban / Rural
Registration number:
Institute name: ___________________________________________________________________

Address: _________________________________________________________________________
_________________________________________________________________________________

Contact no.-________________________ E-mail: _______________________________________

Name of the nature club: ____________________________________________________________

Name of the mentor: ________________________________________________________________

Registration fees:

Urban (one year): Rs.500/-. Renewal: 250/-

Rural (one year) Rs.100/-.  Renewal: 50/-

Total number of members = ________________X Rs.50/- = Rs._________________
Total payable Rs._________________________________________________

The amount can be paid in the form of Cash / Cheque / DD / Bank Transfer.
Cheque/DD should be made in favour of ‘Society for Environment Conservation and Research’ Payable at ‘Mumbai’


Signature of the advisor / Nature Club, GS

Seal of the institute


Please send the complete list of members with their names, class, gender and age.

For official use:

Amount paid __________________ receipt no. ______________dated:______________



Address: 4886/410, C wing, Kshitij Society, Tagore Nagar, Vikhroli - east, Mumbai – 400 083
Email: secr.india@gmail.com web: www.secrindia.org  Contact: 9699949222/8976319379


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