Indian Human Rights Defender

Membership Form

* mark fields are mandatory.

First Name *

Middle Name

Last Name

Father's/Husband/Guardian Name *

Date of Birth *

Nationality *

Gender *

Category *

Marital Status *

Nos of Member in Family *

Height *

Weight *

Aadhaar *

Candidate’s Mobile No. *

Email ID *

Present Address *

Permanent Address * Same as Address for Correspondance

Refered By

Introducer Code *

Introducer Name *

Introducer Phone No *

Reference

Name	Address	Occupation	Phone No

I am willing to work for protection of democratize & Human Rights of people under the committee of Human Rights forum of India. I hereby the rules & regulation of theis organizations not in force. There is no casepending abainst me in any coutt in india.

Place *

Signature *

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Security Text *