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Dear Sir/Madam, Please enroll me as a LIFE member of the Association. I agree to abide by the Memorandum and rules & regulations of the association.

Your Name

CA Membership No.

Company Name

Designation

Qualification

Email

Date OF Birth

Spouse Name

Date OF Marriage

Mobile Number

Phone Number

Resident Address

Official Address

Address where Views Magazine/Circulars should be sent

Office Resident

City

State

Country

ZIP/PIN Code

Password

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