Membership Application Form

I would like to apply for the Membership of The Assam Conservation Trust to join and support its activities.

Name

Email

Mobile No

Address

Aadhaar/PAN

Areas of Interest

Photograph

Brief(<100)

Type of Membership applied for: Patron corporate Life Annual

(Please tick the appropriate box)

I agree to hosting of my profile on the TACT website/Bulletin and to receive notifications for TACT events; I am attaching my brief profile with copies of photograph)

I am enclosing/already paid the applicable Membership Fee vide DD/Cheque/bank Transfer in favor of The Assam Conservation Trust with the following details:

Cheque/DD/NEFT Number in Favor of The Assam Conservation Trust:

Date:

(Please fill and enclose relevant document)

Nominator 1

Name

TACT Membership Number

Signature

Nominator 2

Name

TACT Membership Number

Signature

(Nomination should be by existing Patron/Life members of TACT with Membership Number)

For Office Use Only

Nominations Verified (TACT Office)

Brief Profile and Photograph Received

Payment Verified (Treasurer)

Approved by (Chairman)

Membership Number Issued (Executive Trustee)

Approval with Membership Number Communicated (TACT Office)

TACT Membership Fee and Validity

Type	Fee (INR)	Payable	Validity (Years)	Remarks
Patron	>100000	Once	25	Eminent Person/Organization
Corporate	50000	Once	25	For group membership up to 15
Life	5000	Once	25	One person
Joint Life	4000	Once	25	If attached to a Life Member
Annual	1000	Annual	01	Renewable

Notes:

The Membership Fees may be revised anytime without prior notice; however, the terms of Membership already granted will not change.
Membership is valid for any Chapter of TACT.
Members will receive notifications of TACT events through email.

Membership Form

Membership Application Form