Please complete the following (BLOCK CAPITALS), and return to

Federation of Nepali Journalists, United Kingdom

MEMBERSHIP APPLICATION FORM                                                                                         

Photograph

                                                                                            

Mr/Mrs/Ms/Other –------------ Surname -----------------------------------------------------

First name-------------------------------------------------- -----------------------------  

Address --------------------------------------------------------------------------------------------

              ---------------------------------------------------------------------------------------------

              -----------------------------------Post Code --------------------------------------------

Email -----------------------------------------------------------------------------------------------

Phone --------------------------	Mobile ---------------------------------------------------------

Afiliated Media and Role 
Job Title -------------------------------------------------------------------------------------------

Company/Organisation/Publication------------------------------------------------------------

Or Freelance working regularly for -------------------------------------------------------------

Applicant’s declaration
I confirm that the above information is correct and that I agree to abide by the rules and code of conduct of the FNJUK Chapter

Signature: -------------------------------------------   Date: -------------------------------------
Note:-  please provide your current photograph