PATCA - APPLICATION FOR MEMBERSHIP

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PATCA - APPLICATION FOR MEMBERSHIP

Dignity and intellect are makers of being human – Thanthai Periyar

Cultivation of mind should be the ultimate aim of human existence – Dr Ambedkar

Email *

First Name
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Last Name
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Address
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Mobile No.
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Phone No

Email Id
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Occupation
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Referred by
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Select your membership category
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Life Membership - $1000

Family - $75 per annum

Single Membership - $50 per anum

Associate/Student/ Senior $30 per annum

Required

Are you a member of any right-wing organisation/s or intend to be one in the future ?
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How long are you following Periyar/Ambedkar ?
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Recent

1 – 5 Years

More than 5 years

How familiar are you with Periyar/Ambedkar thoughts ?
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Not Familiar

Familiar

Expert

How would be willing to contribute ?
*

Arts Form

Social Media Management

Attend Meetings to represent PATCA

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