Run No: _____
VIZHITHTHEZHU
(Non-government Organization)
31,1st Lane, Ponnan Street, Purasawalkam,, Chennai – 7. Ph- 9380901902
vizhiththezhu@gmail.com visit:- vizhiththezhu.blogspot.com
YOUTH MEMBERSHIP FORM
INNER BEAUTY
Personal Details
Name: ________________________________________________
Parents Name: _________________________________________
Gender: M ___ F ___ Date of Birth: ____________ Age: ____
Qualification: _________________________________________
Profession: ____________________________________________
Hobbies & Interest: ______________________________________________________
Aspirations: _____________________________________________________________
Contact Details
Address: _______________________________________________________________
_____________________________________________ City______________________
State________________________________________ Pin code __________________
Phone Nos: _____________________________________________________________
Email ID: ______________________________________________________________
I certify that the above details are correct as on date and will notify VIZHITHTHEZHU as and when there may be any change in the details furnished above.I agree to abide by rules and regulations of VIZHITHTHEZHU.
Date: (Signature)
