CHEVSA CLUB

(Official Club of Chevsa Sports Marketing & Management)

MEMBERSHIP APPLICATION FORM -----------------------------------------------------------------------------------------------------------------------------

Type of Membership Annual Membership (1 year validity) Life Time Membership (VIP Club Member)

------------------------------------------------------------------------------------------------------------------Personal Details Full Name: Gender: Male Date of Birth (mm/dd/yyyy): Full Address (To be used for Postal Communication): Female

Contact Number: Phone (with STD/ISD code): Mobile (with country code): Organization/Institute/University/School Name: Email ID (Guardian ID is required if U/18): (I have provided my email id for use by Chevsa Sports Marketing & Management to send me club information such as
E-Magazine & important information)

--------------------------------------------------------------------------------------------------------------------In applying for membership, I hereby agree to Signature abide by the rules of the Chevsa Club. I also agree to pay the membership fee per the schedule set (Guardian Signature if U/18) for this year. (Dated: ) --------------------------------------------------------------------------------------------------------------------Form Submission & Payment Options 1. Please submit the duly filled membership application form by sending the scanned copy over e-mail or directly in person 2. To submit in person please contact us via e-mail/phone at least 48 hours prior of submission. 3. Pay your membership fee by Fund Transfer using Internet Banking/ Cheque/ Cash Payments 4. To choose the appropriate membership scheme for yourself, please refer to the membership information brochure. The membership fee quoted in the brochure is only for personal membership. For the institutional/corporate membership, the membership fee will be conferred upon via email.

5. Cash Payment option is available for Indian Citizens only and for Personal Annual Membership scheme. 6. For payments via cheque please draw the cheque in favour of CHEVSA (SMM) SPORTS MARKETING AND MANAGEMENT LLP. Please do mention your full name & address on the reverse of the check. 7. Banking details for payment by Fund Transfer using internet banking: A/C Name: CHEVSA (SMM) SPORTS MARKETING AND MANAGEMENT LLP A/C Type: Current A/C No: 913020020975325 of Axis Bank IFSC Code for NEFT/RTGS Fund Transfer within India: UTIB0000191 SWIFT Code for Fund Transfer from Abroad: AXISINBB319 8. In case of online fund transfer please mention the unique Transaction ID Generated during Internet Banking Transaction here: ________________________ 9. Please send us a copy of your digital photo and your T-shirt size among Small/ Medium/Large (Which Chevsa will give its members as a complementary joining gift) along with the filled up application form. 10. Contact Info: Email us at info.chevsa@gmail.com or call us at +91-8902254154/9874737237

--------------------------------------------------------------------------------------------------------------------For Official Use only Submission No: Due Date: Membership No:

Chevsa (SMM) Sports Marketing & Management LLP 19A, Jawaharlal Neheru Road, 2nd Floor, Lesley House Calcutta, India 700087 DISCLAIMER: The information transmitted is intended only for the person or entity to which it is addressed and may contain confidential and/or privileged material. Any review, retransmission, dissemination or other use of, or taking of any action in reliance upon this information by persons other than the intended recipient is prohibited. If you received this in error, please contact the sender and delete the material from any computer. This form has been prepared using information believed by the author to be reliable and accurate, but Chevsa (SMM) Sports Marketing & Management LLP makes no warranty as to accuracy or completeness. Chevsa (SMM) Sports Marketing & Management LLP does not accept any responsibility for changes made to this form after it was sent.