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  Print This Page Survey of Members Close this Window
Personal Information
Name of Member :
Name of Parents :
Age :
Date of Birth :
Permanent Address :
City :
Pincode :
Telephone (Home) :
Work :
Fax :
Mobile :
E-mail :
Academic Qualifications :
Extra Curricular Activities :
Date admitted to Samaj :
Work Experience
Name of Organisation :
No. of years in Service :
Last Designation held :
Retirement Activities (if retired) :
Nature of Programmes Attended
Tick all that you find relevant
Utsav : Religious / Musical Functions :
Prayer Meetings : Sunday Services :
Others : Please specify :
In what way can you serve the Samaj
A. Social Service
(a) Samaj Night School for children : Yes No
(b) Proposed coaching center for High School Students : Yes No
(If yes, please mention your subject) :
(c) Samaj Charitable Homeopathic Dispensary : Yes No
B. Literary Service
(a) Publication Activity : Yes No
(b) Library Activity : Yes No
C. Administrative Service
(a) Office Work - Secretarial : Yes No
(b) Office Work - Accounting : Yes No
(c) Office Work - Legal : Yes No
(d) Public Relations Activities - (as an assistant to Samaj office - bearer) : Yes No
(e) Fund Raising : Yes No
(f) Membership Drive and Liaison Work : Yes No
D. Spiritual Service
(a) Ministerial Work (Upasana) : Yes No
(b) Music and Hymns : Yes No
E. Any Other Service
(a) Please Specify :
Your Suggestions
In regard to present activity of the Samaj :
In regard to future activities of the Samaje :
Any improvement you consider practical :
Resources you can mobilise to help the Samaj pursue its own objects :
Any other observations :