Member Registration Form

Read the instructions carefully and submit all necessary details.

Only fields marked in ^* are mandatory. You may skip the other fields, yet we recommend to add as much detail as possible for future communication and collaboration.

Membership Details

Membership Type^*

Life Membership

Patron Membership

Basic Details

First Name*

Middle Name

Last Name*

Mobile *

Email^*

Alternate/Emergency Contacts

Gender^*

Male

Female

Other

Date of Birth*

Address*

Area / Locality*

City / Town*

Postal Pin Code*

State

Personal Information

Educational Qualification*

Employment Status*

Native Place*

Kuladevatha*

Gothra*

Math (Mutt)*

Blood Group^*

PAN Number*

Skills / Hobbies

Attachments

Identity Proof^*

Submit ID Proof Image^*

Upload clear and good quality image with properly visible details.

Drag and drop files here or click to select files

Profile Image^*

Upload clear and good quality image with properly visible face without sunglasses. Preferably plain background.

Drag and drop files here or click to select files

Family Information

Name

Relation

Age (yrs)

Qualification

Profession

Add

Consent

I have read and agree to the terms and conditions.^*

Cancel

Review and Confirm Details

Membership Type:

Full Name:

Mobile:

Whatsapp No:

Email:

Emergency Contact:

Gender:

Date of Birth:

Communication Address:

Educational Qualification:

Profession:

Native Place:

Kuldevatha:

Gothra:

Math:

Blood Group:

Skills:

PAN Number:

ID Proof:

Family Details:

Payment Details

Narration	Amount (INR)
Life Membership Fees	501.00
Entrance Fees	1.00
Total Fees	502.00

Payment Option^*

Pay Later at Samaj

Use this option to Pay at Samaj Office using Cheque, NEFT or QR Code

Pay Online Now

Use this option to Pay online using Credit Card, Google Pay, other UPI, Netbanking etc.

Payment Confirmation

Success!

Your payment was completed successfully.

PAYMENT DETAILS
Life Membership Fees
Receipt No
Payment Method / Ref

We confirm receipt of your Application Form and Membership Fees as per above details.

Your membership application will be reviewed and approved by managing committee. You will receive your membership details upon approval.

We have sent Payment receipt to your registered email id.

Download Receipt

Confirmation

Success!

Your application was submitted successfully.



Acknowledgement No
Payment Status	Payment Pending