Full Name *

Father / Mother Name *

Date of Birth *

Gender *
Select GenderMaleFemaleOtherPrefer not to say

Blood Group (Optional)
Select Blood GroupA+A-B+B-AB+AB-O+O-Not Known

Mobile Number *

Email ID *

Permanent Address *

Current Address *

ID Proof Type *
Select ID TypeAadhaar CardVoter IDPAN CardPassportDriving LicenceOther

ID Proof Number *

Education Qualification *
Select QualificationBelow 10th10th Pass12th PassGraduatePost GraduateDiplomaOther

Occupation / Profession *

Membership Type *
Select Membership TypeGeneral MemberActive MemberAdvisory MemberLifetime MemberHonorary Member

Membership Fee Payment Mode (if applicable)
Select Payment ModeCashUPI / GPay / PhonePeBank Transfer / NEFTChequeNot Applicable

Transaction / Receipt Number (if paid)

Payment Date (if paid)

Passport Size Photo *

Max 2MB — JPG or PNG only

Skills / Expertise

Social Media Profiles

Previous NGO Experience

Reference from Existing Member

Areas of Interest in NGO Activities

Availability for Meetings
SelectAlways AvailableWeekdaysWeekends OnlyAs Required

Willing for Donation / Fundraising?
SelectYes, willing to donateYes, willing to fundraiseBothNot at this time

Suggestions for NGO Development