Membership Application Form

Asttitva Samajik Sanstha, Vasai

Reg No.: F-10434(PALGHAR)

G/2, Miranda Mansion, Behind Janki Theatre,
Prabhu Alli, Parnaka, Vasai (W), Palghar, Maharashtra- 401201

Contact No.: +91 7276143074 | +91 8087367321 | +91 7709194974

We welcome you to become a member of Asttitva Samajik Sanstha, Vasai. Kindly fill up the following details for membership.

Full Name: Mr./Ms./Mrs*

Father's/Husband's Name*

DOB*

Gender*

Member Type*

Phone*

Email*

Permanent Address*

Pin Code*

Present Address*

Pin Code*

Occupation*

Educational Qualification*

Blood Group

Religion*

Nationality*

If, previously associated with any NGO / Organization.

Yes

No

If Yes, NAME of NGO/Organization

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Reason for joining the NGO*

Area(s) of Interest

Education

Health

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Women Empowerment

Child Welfare

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Password*

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