INDIAN SECTION HEADQUARTERS - THE THEOSOPHICAL SOCIETY
GURUBAGH ROAD, KAMACHHA, VARANASI - 221 010 (UP) Affix photo
(Subject to Varanasi Jurisdiction)
MEMBERSHIP APPLICATION/REVIVAL FORM
Date of Application.........................
Objects of The Theosophical Society
First To form a nucleus of the Universal Brotherhood of Humanity without distinction of race, creed, sex, caste or colour.
Second To encourage the study of Comparative Religion, Philosophy and Science.
Third To investigate unexplained laws of Nature and the powers latent in man.
Having considered the three objects of The Theosophical Society, having read the Constitution, Rules & Regulations of the Indian
Section and being in sympathy therewith, I hereby apply for admission as a member of
the Society, and agree to abide by its Constitution and Rules.
FORM TO BE FILLED IN BLOCK LETTERS ONLY
First Name
Middle Name
Last Name
House No
Land Mark
Name of Road
Village/Town
City
Taluka & District
Pin Code State
Mob. No.
Aadhar No., any I.D. with photo
Email Address
Gender (Tick) Male Female Age Date of Birth
Name of Lodge
Village/City
Name of Federation
Signature of Member Signature of Guardian
Date Date
Tick mark one YES if the monthly journal,The Indian Theosophist is required English Yes No Hindi Yes No
Were you ever a member of the Theosophical Society?.........If so, when… To what Lodge and Federation were you
attached?........................................................................................................................................................Diploma No.?...................
Name of Lodge President/Secretary Name of the Federation President/Secretary
Signature of Lodge Signature of Federation
President/Secretary President/Secretary
Date Date
(To be filled in at the President's Office of the Indian Section)
Date of Application Yearly No.
Date Appl. Recd Diploma No.
Serial No. Diploma Date
Signature of President of Indian Section
Form IS-103 dated 15/09/2023
