Top management club membership form

TOP MANAGEMENT CLUB MEMBERSHIP FORM

    Executive President
    Institute of Marketing & Management
    Marketing Tower, B-11, Qutab Institutional Area, New Delhi- 110016

Dear Sir,

I wish to become a member of the Top Management Club. Please find enclosed the Cheque / Draft of Rs. (to be refunded in case of non-acceptance) in favour of ‘Institute of Marketing & Management' towards the Entrance Fee & Annual Membership Subscription. My details are as follows:

Name (in capitals) Mr. / Mrs. / Miss

Date of Birth

Designation

Organisation

Adress:

(a) Office

Phone

Fax

Mobile

E-Mail

(b) Residence

Phone

Fax

Name of the Spouse

Occupation

Professional Interests :

Membership to any other Club / Professional Body

	Entrance Fee	Annual Subscription
Member	Rs.3,000	Rs.12,000
Member's Guest (per meeting)	Rs.1,000

Date Signature