Take A4 size print out of this Application Form and send the duly filled & signed Application to the Secretary along with the DD for the full amount for the Application fee.

YOUNG MEN'S CHRISTIAN ASSOCIATION

KOLLAM-1

APPLICATION FORM FOR HOSTEL ACCOMMODATION

Fix here your Passport size
Photo Graph

Name (in Capital letters) ..................................................................................................................

Residential Address  ........................................................................................................................
 .........................................................................................................................................................
Pin .............................  Phone/Mobile...............................................

Office/College Address ....................................................................................................................
 ..........................................................................................................................................................

Pin .......................................................  Phone/Mobile.................................................

Date of Birth ........................................  Nationality .....................................................

Religion ........................................................................................................................

Conditions: Hostel accommodation is open to any person of good character, regardless of Caste, colour and  creed, according to the availability of the rooms.

I accept the terms & conditions of YMCA Kollam.

Introduced by

(Only Existing Members)

 

Signature

Name

1......................................................................

2......................................................................

 

...............................................

...............................................

Date:

Signature of the Applicant


(For Office purpose only)
Approved by the Board on ...............................................................

 

Admission Fee Rs. ........................................

Receipt No. ..................................................

Membership No. ..........................................

 

Signature of the Secretary        

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