Name of Organization Email* Phone/Mobile Address Chief Executive Name and Designation Core activities of the organization Select the type of membership Nomination of one representative in General Body of BHAVANA - Fee Rs. 5,000/- Nomination of two representatives in General Body of BHAVANA - Fee Rs. 10,000/- Distinguished Membership of Spouse - Rs. 1000.00 Nomination of three representatives in General Body of BHAVANA - Fee Rs. 15,000/- Nomination of four representatives in General Body of BHAVANA - Fee Rs. 20,000/- Nomination of five representatives in General Body of BHAVANA - Fee Rs. 25,000/- Government & Semi Government Organizations and Commercial Establishments - Fee Rs. 25,000/- DETAILS OF PAYMENT Mode of payment Cash DD Cheque Amount in figure: Details of Cheque/DD