Membership Interest Form

Fill out this form to express your interest in membership. Our team will contact you with next steps.

Full Name *

Phone Number *

Email Address *

Date of Birth (B.S.)

Gender

Blood Group

Province

District *

Municipality / Rural Municipality (Palika)

Ward No.

Address (Tole / Street)

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Membership FeeRs. 500

Pay Rs. 500 using the QR code, then enter the transaction ID below.

Transaction / Reference ID *

JPG or PNG, up to 8 MB each.

Passport Size Photo *

Choose imageJPG or PNG, up to 8 MB each.

Citizenship Certificate (Front) *

Choose imageJPG or PNG, up to 8 MB each.

Citizenship Certificate (Back) *

Choose imageJPG or PNG, up to 8 MB each.

Your documents are stored securely and used only to verify your membership.

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