Samabima party membership application form
නම | பெயர் | Name *
විද්යුත් තැපෑල | மின்னஞ்சல்) | Email *
ලිපිනය | முகவரி | Address *
දුරකතන අංකය | தொலைபேசி எண் |Phone number *
ඔබ පක්ෂය සමඟ සම්භාන්ධ වන්නේ ? | நீங்கள் கட்சியில் சேருங்கள்? | You join with the party? *
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