Membership Application

Full Name *

Name on Membership Card *

Image *

House Name/No *

Place *

Post Office *

District *

State *

Country *

Pincode *

Date of Birth *

Father's Name

Marital Status

Nominee Name *

Relationship with Nominee *

Blood Group

T-Shirt Size *

Mobile Number *

Home Number

Email Id *

Type of Membership *

Platinum (Life Member) - ₹ 1000 Gold (2 Years) - ₹ 250

Subscription Charges *

Yearly - ₹ 1200 Monthly - ₹ 100

*By clicking on Submit I declare that I would like to be a member of UFP Club, Poovathussery and hereby agree to abide by the rules and regulations of the Society.