Membership Application

Kindly print & fill the membership details and send it to us.

To:
National Kidney Foundation (India)
FAD Centre, Under the Flyover
Next to Parsi Gymkhana
E-Road, Marine Drive
Mumbai - 400 002
India

I / We wish to enrol as:

      -          Associate member   Rs. 200 (renewable annually)

-          Life Member              Rs. 1,000

-          Patron member         Rs. 10,000 and over

-          Donor member          Rs. 25,000 and over

   (Please tick as appropriate)

Enclosed is a cheque/draft for Rs.                for my/our membership dues.

Member's Name:

Address:




Tel:

Signature:

Date:

(Name & Designation in case of corporate Members)

Thank You.

Member

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Copyright ©, NKFI

NKFI, FAD Centre
Next to Parsi Gymkhana
E Road, Marine Drive
Mumbai 400 002
INDIA

Tel: +91 (22) 22814892
       +91 (22) 22817914
Email:nkfisatnam@vsnl.net

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