Application Form

Application For Membership

[ ] Life Membership	[ ] Institutional membership			[ ] Annual ordinary membership
Rs 2,000 (US$ 400) lump sum or	Rs.20,000 (US$ 1000) lump sum			Rs. 600 (US$ 90)
Rs. 420 (US$ 84) in 5 equal installments
M.O/Cheque/DD No. _____________ dt. ______________ ( should be cashable at Thiruvananthapuram, Kerala, India. )
Post Office/ Bank through which the Membership fee is remitted ___________________________________________
Place __________________
Date __________________
Signature _______________
To The Treasurer Dravidian Linguistics Association V.I. Subramoniam Memorial ISDL Complex St. Xavier's College P.O. Thiruvananthapuram - 695 586 Kerala, India

For Office Use
Receipt No.	:	_______________	Details of remittance : _______________
Date of Membership	:	_______________
			Treasurer/Secretary : _______________