Nature Club Surat
Email address
Diwali - Dang Camp 2017
Dang Adventure Damp
Nature Education Camp - Dang 2017 (3 nights/4 days)
Batch
Name
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Address
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Pin Code
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Phone
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Age
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Male / Female
Occupation
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Hobbies
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School/College/Business/Company Name
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Already a NCS Member?
Blood Group
Allergic to
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Date: (Form filled)
MM
/
DD
/
YYYY
Amount Paying
Kindly take a print of this form and submit Amount in cash/cheque to Club office at 81, Sarjan Society, Parle Point, Surat
Risk Certificate
Dear Sir,
I hereby declare that I am sending my Son/Daughter/Mr/Miss to the camp at my own risk. Nature Club or any of its office bearers will not be held responsible in case of any accident or injury during the camp or during to and fro journey.
For Office Use Only (When paying in cash or cheque)
Received Amount Rs.


Date : Receiver's Signature

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