Carnatica Club - Registration Form

Carnatica Club Registration

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Name

Age

years

Sex

Male Female

Street Address

Country

Telephone

Office Home

Fax, if any

Choose a User ID

Choose a password

(Case sensitive)

Confirm password

(Case sensitive)

How did you come to know about Carnatica.net?

Your Interest Areas

Are you a

Membership Category

Mode of Payment

Cheque Details:

Cheque number

Cheque date

(dd/mm/yyyy)

Drawn on Bank

Branch

Account number

Note:

Cheques are to be made in favour of Srishti's Carnatica Pvt. Ltd. and mailed to Shirdi Towers, #9, Arulambal St., T. Nagar, Chennai - 600 017, India.
Admittance to the Carnatica Club is subject to realisation of the cheque.