User Application Form

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JAY PRAKASH MEMORIAL FOUNDATION

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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Yearly Membership Fee - 500/-

Five Membership Fee - 2000/-

Lifetime Membership Fee - 5000/-

Bank Detail - CENTRAL BANK OF INDIA

UPI SCAN:

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