User Application Form

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Chhattisgarh Patrakar Jankalyan Samiti

Registration Form

Name * :

Gender * :

Date of Birth * :

Profession:

Blood Group *:

State * :

District *:

Mobile No. *:

Aadhar No. *:

Address *:

Pin Code *:

Email:

Profile Picture:

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Other Document

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Membership Fee - 1200/- (1year)

पत्रकार मित्र सहयोग राशि - 300 /-

Bank Detail -

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