Membership Application Form: Indian Section Headquarters - The Theosophical Society

Download as pdf or txt
Download as pdf or txt
You are on page 1of 1

INDIAN SECTION HEADQUARTERS - THE THEOSOPHICAL SOCIETY

GURUBAGH ROAD, KAMACHHA, VARANASI - 221 010 (U.P.) Tel +91-542-245-0776


MEMBERSHIP APPLICATION FORM
Objects of The Theosophical Society
First To form a nucleus of the Universal Brotherhood of Humanity without distinction of race, creed,
sex, caste or colour.
Second To encourage the study of Comparative Religion, Philosophy and Science.
Third To investigate unexplained laws of Nature and the powers latent in man.
Having considered the three objects of The Theosophical Society, and being in sympathy therewith, I
hereby apply for admission as a member of the Society, and agree to abide by its Rules.
FORM TO BE FILLED IN BLOCK LETTERS ONLY

Name of Lodge
At (Village/City)

Tick if Unattached Signature of Applicant

Date Signature of Guardian


First Name
Middle Name
Last Name

House No/Land Mark


Name of Road
Village/Town/City
Taluka & District
Pin Code State
Mob. No.
Email Address
Gender(Male/Fem) Age Date of Birth
Tick mark YES if the monthly journal, The Indian Theosophist(English), is required Yes No
Tick mark here if you are a spouse of a full paying member
Full Name and Diploma No. of full paying spouse Dip. No.
Have you ever been a member of the Theosophical Society? if so, when
and
Name toof
what Lodge
Lodge andwere you attached?
Federation to
which applicant may join
Signature of Lodge Signature of
Secretary Federation Secretary
Date Date
(To be filled in at the President's Office of the Indian Section)
Annual Dues Received Rs Yearly No.
Entrance Fee Rs Diploma No.
Journal No./Voucher No. Diploma Issue Date
Date of Voucher
ADS & Serial No. President of Indian Section
Form IS-101 dated 04/12/2019

You might also like