Members – The Voice of Odia Artists | The Voice of Unity | The Voice of Identity | The Voice of Odisha

Membership & Donation Form

Membership & Donation Form

Name:

Father's Name:

Mother's Name:

Category:

Marital Status:

Married Unmarried Divorced Widowed

Qualification:

Address:

Language(s) Known:

Aadhar Card No.:

PAN Card No.:

Sex:

Male Female Other

Date of Birth:

Blood Group:

Profession:

Experience (if any):

Yes No

How many years of experience in this field?

Upload Photograph:

Select Donation Amount:

₹500 ₹1000 Other Amount

Enter Other Amount (₹):

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:

Place:

Signature (Type your full name):

Telegram

Email

Phone

WhatsApp

Messenger

Messenger

WhatsApp

Phone

Email

oksodisha@gmail.com

Telegram