NGO - Register Form

NGO

New Member Entry

Member's Personal Details

Admission Date* :

First Name:*

Middle Name:

Last Name:*

Date of Birth* :

Gender :

Male Female

Blood Group :

Religion :

Category :

Aadhar No.:

Mobile :

E-mail :

Membership Details

Membership Type :

Life Care Mission, An Effort To Save Life:

1. Do you want to join the organization’s life saving campaign?

2. Are you ready to donate blood if needed for the suffering person?

3. Are you ready for eye donation?

4. Do you agree to the gift of your death body to a medical research institution after death for human service and medical study ?

I, declare with my wish/consent that , I am joining the organization’s life care campaign without any pressure. My family will also be responsible for fulfilling my above wish/consent.

I, Declare that all the information given by me is absolutely true.

Member's Parents Details

Father's Name :*

Fathers's Mobile :

Father's E-mail :

Father's Occupation:*

Mother's Name :*

Mother's Mobile :

Mother E-mail :

Mothers's Occupation:*

Siblings :

Member's Contact Details

Organization Name :

Organization Address :

Designation:

Current Address*

Current City*

Current State* :

Current Pin Code*

Permanent Address*

Permanent City*

Permanent State*

Permanent Pin Code*