Lifetime Membership Form (UG)
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Title
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Mr.
Ms.
Mrs.
Dr.
Vd.
Name
Relation (S/O D/O W/O)
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S/O
D/O
W/O
Father/Husband Name
Email
Create Password
Mobile Number
WhatsApp Number
Gender
Select your gender
Male
Female
Other
Date of Birth*
Day
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Year
Permanent Address with Pin Code (Address to be printed on download certificate)
City
Permanent State
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Andaman and Nicobar Islands
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Dadra and Nagar Haveli and Daman and Diu
Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu and Kashmir
Jharkhand
Karnataka
Kerala
Ladakh
Lakshadweep
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Puducherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
International
Permanent District
-- Select a State First --
Pin / Zip Code
Name of Institute
Present Address*
Present State
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Andaman and Nicobar Islands
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Dadra and Nagar Haveli and Daman and Diu
Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu and Kashmir
Jharkhand
Karnataka
Kerala
Ladakh
Lakshadweep
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Puducherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
International
Present District
-- Select a State First --
Studying Year
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1st Professional
2nd Professional
3rd Professional
Admission Year
Online
Cash
Cheque
Attach a profile photo
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File size must be less than 5 MB.
Reference*
(Please provide the name and contact number of any VAP member or Office bearers known to you.)
Reference Name
Reference Phone Number
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Membership Fee: Rs. 1100 only