Membership KARNATAKA STATE GOVERNMENT FIRST GRADE COLLEGE SC-ST TEACHERS ASSOCIATION (R)Regd. No. SOR/GNR/229/2014-15 MEMBERSHIP REGISTRATION FORM Name of the Teacher (In Capital Letters) Designation Educational Qualification Date of Birth Date of entry in to the Service Date of Retirement KGID Number Parents / Guardians Name Mobile Number Email Address Present College Full Address with Pincode. Full Address for Communication with Pincode Permanent Address with Pincode Blood Group I , Mr./Miss./Prof./Dr. this is to certify that, the above information I have provided true and best of my knowledge. Upload passport size photo (Size: Less than 200KB JPEG Format) ______________________________________________________________ Upload Signature (Size: Less than 200KB JPEG Format) To make an online payment of ₹2000 using a QR code Select SelectEnter Transaction ID Enter Transaction ID I Agreed, terms and conditions, rules and regulations laid down by association. QR Code Bank Details ACCOUNT NO : 1035111020000221 IFSC CODE : KSCBO001035 NAME: Karnataka State Government First Grade College SC/ST Teachers Association