Membership Form

Full Name*

Father's Name*

Mother's Name*

Gender*

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Date of Birth*

Date

Category*

Disability*

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Mobile No.*

WhatsApp No.*

Email address*

example@example.com

Permanent Address Details*

Current Address Details*

State*

District*

Assembly Constituency*

Voter id No.(EPIC)

Pin Code*

Educational Qualification*

Name of Your School / College ?*

Name of your University?

Which city Is your School / college in?*

Membership Referred by*

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Signature

Declaration*

I hereby declare i am citizen of indiaI have full faith in the purpose and approach of the organization and i will follow the constitution, rules and discipline of the organizationI consent to receiving any communication from the organization either in writing, electronically and/or in any audio-visual format via phone (including SMS/MMS), email and/or at my address.The particulars and statements made above are correct to the best of my knowledge and nothing has been concealed or withheld.

Young Revolutionary Student's Association