|
Application form for Enrolment of
Membership
(As per Rule –6)
Name (in block letters)
:-
Age :-
Profession :-
Designation :-
Residential Address in full :-
Name
& address of the Establishment :-
With
which the applicant is employed / attached and since when the
establishment is registered with RNI
Amt
of salary/honorarium/retainer :-
Fee
being drawn per month
8.If
you are an owner-cum-editor, please state
Name
of your newspaper and place of its publication with address :-
When
your newspaper was established :-
Whether it is published regularly :
Periodicity of its publication:-
What
is your main source of income :-
Do
you fully depend on the income of your newspaper to maintain your
livelihood. :-
What
is your principal avocation :-
Your
telephone/FAX/Internet
No.
if any :-
It is
hereby declared that I fully agree to conform to the Rules
Regulation and Code of Conduct and the Constitution of the Club and
to such alterations as may from time to time be made by the Club and
understand that action against me under rule (9) may be taken for my
activities against the interest, welfare or reputation of the Club
and against the journalistic ethics. It would be my moral
responsibility to abide by the objects of the Club as stated in the
“Memorandum of Association” of the Club.
The
above statement is correct to the best of my knowledge and belief.
Proposed by :-
(Full
signature)
Name
of the establishment in which serves :-
Address :-
Date
:-
Seconded by :-
(Full
Signature)
Name
of the establishment in which serves :-
Address :-
Date
:-
Date
, Agartala………………….
Full
signature of the applicant.
(Proprietor/Editor’s certificate confirming three years of
uninterrupted service at Agartala with a salary/ honorarium/
retainer fee of not less than Rs. 1000.0 per month must be submitted
along with the application form).
(A sign declaration to the effect that the news paper – weekly or
daily – provides the applicant with the main source of his income
must be submitted along with the application form).
Space for use by the Office
Secretary
|
