GYM MEMBERSHIP FORM 1. 2. 3. 4. 5. 6. 7. 8.

Name Fathers Name Occupation Date of Birth Address NIC No (Att a Copy) Emergency Contact Any Physical Handicap : : : : : : : :

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SPONSORSHIP (CIVILIAN) BY AN ARMY OFFICER 9. Certified that I personnally know Mr_________________________S/O Mr_______________________________and recommend him for membership of the College Gym.

Signatute: Name : Rank : Appointment/Address: Date: OFFICIAL USE ONLY 10. 11. 12. 13. 14. Membership Recommended by Gym Secretary. Membership fee of Rs 1,000.00 received and deposited with SI ECA. Approved by Sponsor DS Informed SI ECA. Date