SLOBA
ST. LAWRENCE OLD BOYS' ASSOCIATION

MEMBERSHIP APPLICATION FORM

The Secretary                                                                                Receipt No.
St. Lawrence Old Boys' Association
St. Lawrence High School                                                             Membership No.
27, Ballygunge Circular Road
Calcutta - 700 019                                                                        PLEASE USE CAPITALS

Dear Sir,

        I desire to be a Life/Ordinary Member of the Association and agree to abide by the Rules and Regulations as will be in force from time to time.
        My particulars are as follows :

1. FULL NAME (SURNAME FIRST)                                ___________________________________________

2. RESIDENTIAL ADDRESS                                              ___________________________________________

                                                                                                ___________________________________________

                                                                                                PHONE NO : _________________________________

3. PROFESSION                                                                    ___________________________________________

4. OFFICE ADDRESS                                                          ___________________________________________

                                                                                                PHONE NO : _______________FAX ______________

5. NAME OF SPOUSE                                                        ____________________________________________

6. BLOOD GROUP                                                              ____________________________________________

7. YEAR OF JOINING SCHOOL      ___________        (CLASS :          )
    YEAR OF LEAVING SCHOOL     ___________        (CLASS :         )

My subscription of RS. ________ for the year __________ to _________/for Life Membership is enclosed.

Date :                                                                             Signature


Note :     Clubbed subscription for Ordinary Membership for 4 years : RS. 100/-
                Subscription for Life Membership : RS. 500/-
                Cheques to be drawn in favour of "ST. LAWRENCE OLD BOYS’ ASSOCIATION"