INTERNATIONAL PRESS AND MEDIA ASSOCIATION

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NoYúRN Tj§¬dûL Utßm FPL NeLm
[Registered under Societies Act XXI of 1860, Govt. of India]
Head office: No: 21/B, THIRUVEETHI AMMAN KOIL STREET, MANNURPET, CHENNAI – 50.
Contact: 9600983838 / 9600984848 / 9600985858 / 9600986868 / 9841071482 / 8015000110
E-mail: internationalpressmedia@yahoo.com pnk.indian@yahoo.com
Website: www.internationalpressandmediaassociation.org
Affix

MEMBERSHIP FORM Photo

(FILL IN BLOCK LETTERS) Here

DATE OF JOINING: ……………………. ID CARD NO: ………………………..

Name: ……………………………………… Father / Mother Name: …………………………..

D.O.B: ………… Wedding Day: ………………. Blood Group: ……………. Sex:……………….

Present Address: ……………………………… Permanent Address: ……………………………….

…………………………………………………….. …………………………………………………………..

…………………………PIN …………………….. ……………………………PIN ………………………..

Marital Status: ………………………… Spouse Name: ………………….,D.O.B: ……………………,

Son: …………….., ………………, ………………… D.O.B:……………….., ……………., ……………..,

Daughter: …………………, ……………….., …………… D.O.B: ………………, …………, ………….

Qualification: ……………………….. District : …………………………………….

Community : Hindu Christian State : ………………………………........

Muslim Nationality : ……………………………………..

Occupation: ……………………………… Emergency contact No: ………………………….

Occupational Address: ………………………. Landline with STD code: …………………………

………………………………………………….. Cell: …………………….. What’s app: …………….

……………………………PIN……………………... E-mail id: ……………………………………………

Office Phone: …………………………… Website: ……………………………………………..

Two Wheeler Four Wheeler If Advocate yes No

Vehicle No: …………………………………….. Bar Council ID Card No: ………………………….

(Two Wheeler)
Area Police Station: ……………………………….
Vehicle No: ……………………………………..
(Four Wheeler)

Introducer Name: ………………………………Cell: …………………Landline …………………….

(Friend)

Introducer Address: ………………………………………………………………………………………..

…………………PIN…………………., E-mail id: ………………………., What’s app: ………………….

Introducer signature:……………………………………….., Date: ………………………………………

1. Are you a member of any other Organization or Political Party : yes No

2. If, any FIR against your Name : yes No

3. Any Case Pending in court : yes No

4. Have you already joined in any Press : yes No

5. Are you already joined in any Press Association : yes No

Date : Applicant’s Signature

 OFFICE USE ONLY

Hereby examined all your details and approve disapprove applicant.

Association Card No :

Designation Granted :

Renewal Date :

Handling Person Name & Date :

Signature Secretary Signature President

Seal: Seal :

Date : Date :
PLEDGE
 I respect the sovereignty of India.
 I never Indulge myself in any Criminal activities which against the Indian law.
 I abide by the rules framed by the Association.
 I will strive for the betterment an uplifment of the Association.
 Irrespective of Religion, Caste or Language, I will put my effort to enable unity.
 I hereby agree to strictly adhere to the above pledge, I also understand that in the
event of violation of the pledge. The President reserves the right to cease my
membership & Posting Id card.
 I will serve the people & society as volunteer for which I will not claim any kind of
payment or service charges for any kind of expenses from the administration.
 I am joining with my own acceptance and consent and not been forced by any one.

READ ALL OUR AIMS, OBJECTIVES , RULES AND RESPONSIBILITIES:-

 The administration or the President will not be responsible for any misuse of
association card, or if any illegal activities committed in future.
 The association card is non-transferable and once the payment is made, it is non-
refundable.
 On expiry of validity ID card, you must submit the association card to administration
office within 30 days for renewal, if you failed to renew, and the association card will be
automatically terminated.
 In case of change of address or contact number you must inform to the
administration office.
 In case the loss of the identity card, then you must inform to the administration office,
and duplicate card chargeable will be Rs.250/-
 If you found guilty floating the rules and regulations, you will be punished and strict
action will be taken under the press and societies act and results in termination of
your association card.
 Only the association card holders should use the association stickers / badges of
“International Press and Media Association”
  You should not make any duplicate association card and issue to others.
 Every 3 months International Press and Media Association meeting will be conducted
by association members.
We are having other organization
NAMADHU DHESAM (Tamil Monthly Magazine)
SUÕ úRNm (Rªr UôR CRr)

INTERNATIONAL HUMAN DEFENCE ORGANIZATION

NoYúRN U²R TôÕLôl× AûUl×

INTERNATIONAL PEOPLE PROTECTION MOVEMENT

NoYúRN UdLs TôÕLôl× CVdLm

INTERNATIONAL EDUCATIONAL AND CHARITABLE SOCIETY

NoYúRN Lp® Utßm A\dLhPû[ NêLm

We are having other Five Trust and doing many social activities for downtrodden people if you can
join with us and make Donation and save this people

P.N.K.INDIAN TRUST - ©,Gu,úL, Ck§Vu A\dLhPû[

BLIND PEOPLE’S DEFENCE TRUST – LuTôoûYVtú\ôo TôÕLôl× A\dLhPû[

PHYSICALLY CHALLENGED PEOPLE’s DEFENCE TRUST – EPp F]Øt\YoLs UdLs TôÕLôl× A\dLhPû[

LEPROSY PEOPLE DEFENCE TRUST - ùRôÝúSôn UdLs TôÕLôl× A\dLhPû[

AIDS PEOPLE DEFENCE TRUST – Gnhv UdLs TôÕLôl× A\dLhPû[

INSTRUCTIONS:-

 All Payments should be made by DD / Cheques / Cash which is informed by

administration office.
 After depositing money, mail us your receipt details at
internationalpressmedia@yahoo.com , pnk.indian@yahoo.com and inform to the
administration compulsorily.
 Submit the complete form with 3 Nos. Passport size photos, Address ID Proof.
 Send all documents by courier / Registered Post to the Admin office.

FOR ANY QUERY: ADMIN OFFICE 9.00 A.M TO 7.00 P.M Cell: 9600986868