Name *

Father’s/Husband’s name

Mother’s name

Date of Birth

Year of Study in the Institution

Educational Qualification till date

Present Address

Pin Code

Tel/Mob No *

Email Id *

Present Occupation (Govt. Service / Private Service/ Business)

Designation

Address of Present for Posting

Place of Work

Any Special Information about yourself

Membership Fee
 Annual Membership : Rs. 200 Life Membership : Rs. 1000

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