Membership Form

Fill in the form below and submit it online, or download the PDF and submit it in person.

Please accept Life Membership in your club. I am enclosing a cheque for ₹5,500 (Rupees Five Thousand Five Hundred only) in the name of "New Bengal Club - Thane". This includes ₹5,000 for Life Membership + ₹500 for the first year's subscription (subsequently ₹500 to be paid every year as annual subscription).

Applicant's Details

I, hereby undertake that the information provided above is true to my knowledge and I shall abide by the rules & regulations of the club.

Introduced By

Spouse Details

Children's Details