MEMBERSHIP FORM - EKATA MANCH
EKATA MANCH 
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Senior Citizen *
Referred by (Name & Contact Number)
Name* *
Date of Birth
MM
/
DD
/
YYYY
Residential Address 
Occupation *
Name & Address of Office
Mobile Number *
Email Address *
Terms & Conditions
1. I wish to join EKATA MANCH. I am aware of the objectives of the Manch.
2. I certify that, I am not involved in any criminal Case
3. I hereby declare that I will not misuse my status and privileges as a member of EKATA MANCH.
4. I will strive to the best of my ability to serve the nation and society, in every possible manner.
I Agree to the above said Terms & Conditions
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