Membership & Donation Form

Membership & Donation Form

Name:

Father's Name:

Mother's Name:

Category:

Marital Status:

Married Unmarried Divorced Widowed

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Address:

Language(s) Known:

Aadhar Card No.:

PAN Card No.:

Sex:

Male Female Other

Date of Birth:

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Experience (if any):

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Select Donation Amount:

₹500 ₹1000 Other Amount

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Declaration

I hereby declare that the information provided above is true and correct to the best of my knowledge and belief. I understand that any false information may lead to the cancellation of my membership and/or donation.

Date:

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Account Details

* ODIA KALAKARANKA SWARA
* A/C No.- 32600110097977
* IFSC Code – UCBA0003260

After making Payment send a screen shot to this whatsapp no :
9437397123

DONETION LIST DETAILS

Sridhara Martha
Sarthak Pradhan
Purna Khuntia
Siba Narayan Pujapanda
Rusi Pattanaik
Barada Prasanna Patra
Mrunmaya Nayak
Mili Mishra
Sabita Sahoo
Bishal Sahu

Ronit Panda
Kaberi Satapathy
Rajesh Agarwal
Prakash Kumar Swain
Dr.Sanjeeb Das
Lakhmipriya Panda
Sabita Champati
Gyanade Khuntia
Bijayalaxmi Mohanty
Sambit Barik

------------------------------------------------------------------------- TOTAL DONETION COLLECTED MORETHAN 1 LAKH

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