Membership Registration Form

FRIENDS OF KOLKATA'S ELDERLY (FOKE)

Annual Membership Form
To enrich Friends of Kolkata’s Elderly with your membership please fill up this form: Minimum membership fee is Rs. 1000/- per year. (To be renewed every year) An account payee cheque to be made in the name of Friends of Kolkata’s Elderly or payable by NEFT/ any mode of online payment.
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail:*
Phone Number*
PAN Number(Optional)
I've paid through ChequeI've paid through IMPS/NEFTI've paid through CashI'll make the payment here
If membership amount paid in cheque please mention the details below.
Cheque Number
Date of Cheque Issue

MonthDayYear
Date
Paid For the Year
If payment is made through IMPS please fillup the following details below and upload an image.
Transaction ID
Transaction Date

MonthDayYear
Date
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To make payment click on the 'Donate' button, and after successful payment please upload a screenshot of the payment completion page.
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Comments or Queries
FOKE city office, 74 C, S.N Banerjee Road, Kolkata 700 014.

Email fokeindia@yahoo.in :

Mob: 9883339004

Bank Details :Name of the Account: Friends of Kolkata’s Elderly

Account Number: 0528000100106434

IFSC: PUNB0052800
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FRIENDS OF KOLKATA'S ELDERLY (FOKE)