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1
Personal & Contact Details
Title / संबोधन
*
Mr.
Mrs.
Ms.
Shri
Smt.
Dr.
Full Name / नाम
*
Sex / लिंग
*
Male / पुरुष
Female / महिला
Other / अन्य
Father's Name / पिता का नाम
*
Date of Birth / जन्म तिथि
*
Email / ईमेल
Mobile No. / मोबाइल नंबर
*
WhatsApp No. / व्हाट्सएप नंबर
Occupation / व्यवसाय
*
Select
Business
Daily Wage Labour
Farmer
Govt. Service
Homemaker
Private Service
Social Worker
Student
Teacher
Unemployed
Other
Education / शिक्षा
*
Select
Below 5th
Below Matric
Matric / 10th
Intermediate / 12th
Graduate
Post Graduate
Professional Degree
Other
Specify occupation / व्यवसाय बताएं
Specify education / शिक्षा बताएं
Photo / फोटो
JPG/PNG/WEBP, under 1 MB.
2
Address
State / राज्य
*
Select
Jharkhand
Odisha
West Bengal
District / जिला
*
Select State First
Sub-Division / अनुमंडल
*
Select District First
Area Type / क्षेत्र प्रकार
*
Rural / ग्रामीण
Urban / शहरी
Block / प्रखंड
*
Select Anumandal First
Panchayat / पंचायत
*
Select Block First
Nagar Nikaya / नगर निकाय
*
Select Anumandal First
Village / Mohalla / गाँव / मोहल्ला
*
Ward / वार्ड
*
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100
Landmark / नज़दीकी स्थान
Pincode / पिनकोड
*
3
Membership & Payment
Membership Type / सदस्यता प्रकार
*
Select
पिलर मेंबर — ₹21
प्रखंड समिति — ₹100
जिला सदस्य — ₹200
जिला पदाधिकारी — ₹500
जिला अध्यक्ष — ₹1,000
सांसद — ₹5,000
विधायक — ₹5,000
पूर्व विधायक — ₹5,000
आजीवन सदस्यता — ₹21,000
Scan with any UPI app to pay
₹0
Transaction ID / UTR No. / लेन-देन आईडी
*
Notes / टिप्पणी
I confirm the details entered above are correct, and I consent to AJSU PARTY storing this information for membership records.
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