LA Club Registration Form This form can be photocopied and send by post
Name: …………………………………………………………………………........…………...
Surname Middle Name Name
Gender: Male/Female…….…….. DOB…………… Birth time………….... AM/PM
Profession …………………………………………………..…….........……………………..
Name of the Organisation: ………………………………………………….....………….
Address: ……………….……………………………......……….……City: .....……………..…
State: ……………….……............…. Pin Code: ………………….....…….....….……...
Phone No: ……………….…….....……… Mobile No: …………….......………………….
Website Name Type of membership: www..…………………......………………....
Annual membership Fee: Individual membership, non transferable, all facilities can be availed for 1 year: Rs. 3999/-
5 Years Membership Fee: Individual: 15000/-
One time registration Fee: : Rs. 999/-
Which includes LA-Club Kit, membership card, LA-Club Memento, LA-Club certificate & Information sheet.
Please find enclosed Cheque/DD No ............................ Dated ……….......………… Drawn on ………….…………… Bank, for Rs. ….........………......
Favouring Vastu Tectonics Pvt. Ltd., Payable at Pune.
POStal addreSS VastU tectonics Pvt. Ltd.S24,
East Street Galleria,2421 East. Street, Pune -41 1001 Maharastra, India. Tel. : 020-6354487 Fax : 020-6343566
Terms and Conditions:
1.Membership is non-transferable.
2.Membership fee is non-refundable.
3.LA Club reserves the right to cancel the membership of a member, in the case that the latter has been found
indulging in practices detrimental to the interests of the club.
4.Seminars and workshop will be conducted as per the priorities of the club's managing committee.
5.LA Club will not be responsible for any misleading information given out or controversial statements
made during seminars or workshops by a third party.
6.We are not responsible for any th ird party products and information.
7.Due to unavoidable circumstances the event schedule may be cancelled or rescheduled. LA club reserves
all right for scheduling seminars and workshops.
8.All disputes that arise shall be resolved within the Pune Jurisdiction.
Applicant Signature
For Office Use
……………………. Membership Number
Date of receipt
…………………………… Admin Signature
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