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Club Name :
VASAVI CLUB UNIVERSAL
Club Code :
VCI333
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Member information
Member Name
*
Gender
Male
Female
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Date of Birth
*
(dd/mm/yyyy)
Educational Qualifications
Name of Spouse
Date of Marriage
(dd/mm/yyyy)
Date of Birth of Spouse
(dd/mm/yyyy)
Blood Group
---Select Blood Group---
A+
A-
B+
B-
O+
O-
AB+
AB-
Gothram
*
No.of Child (Male)
No.of Child (FeMale)
Mobile Number
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Mobile / Telephone (Residence)
Land Line
Email Id
Address
*
City
*
Pincode
*
State
*
---Select State---
ANDAMAN AND NICOBAR ISLANDS
ANDHRA PRADESH
ARUNACHAL PRADESH
ASSAM
BIHAR
CHANDIGARH
CHATTISGARH
DADRA AND NAGAR HAVELI
DAMAN AND DIU
DELHI
GOA
GUJARAT
HARYANA
HIMACHAL PRADESH
JAMMU AND KASHMIR
JHARKHAND
KARNATAKA
KERALA
LAKSHWADEEP
MADHYA PRADESH
MAHARASHTRA
MANIPUR
MEGHALAYA
MIZORAM
NAGALAND
ODISHA
PONDICHERRY
PUNJAB
RAJASTHAN
SIKKIM
TAMIL NADU
TELAGANA
TRIPURA
UTTAR PRADESH
UTTARAKHAND
WEST BENGAL
OTHERS
ℹ️ Please select Others State for NRI's
Country Name
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Membership Term
Membership Term Name
1 Year
2 Years
3 Years
4 Years
5 Years
Term Amount
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Term Years
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