For General Member - Denzong Sherpa Association

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Annual Membership Fee - Rs. 100

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<div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="text"><div class="form-group"><label for="text-1690717501610">Full Name</label><span>*</span><input type="text"  name="text-1690717501610" placeholder="Full Name" class="form-control" required data-msg-required="This field is required."></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="text"><div class="form-group"><label for="text-1690717517358">Name of Father &amp; Mother</label><span>*</span><input type="text"  name="text-1690717517358" placeholder="Name of Father &amp; Mother" class="form-control" required data-msg-required="This field is required."></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="text"><div class="form-group"><label for="text-1690718221728">Ru (Clan/Thar)</label><span>*</span><input type="text"  name="text-1690718221728" placeholder="Ru (Clan/Thar)" class="form-control" required data-msg-required="This field is required."></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="datePicker"><div class="form-group"><label for="datePicker-1690718262525">Date of Birth</label><span>*</span><div class="input-group f-b-date-timePicker"><div data-related-id="datePicker-1690718262525" class="fake-input form-control date-time-picker" data-date-format="m/d/Y"><span class="s123-calendar-handler-placeholder">Date of Birth</span></div><input type="hidden" data-id="datePicker-1690718262525" name="datePicker-1690718262525" value="" required data-msg-required="This field is required."><span class="input-group-addon f-b-date-timePicker-icon s123-calendar-handler-icon"><i class="svg-m s123-icon-converter " data-icon-name="calendar" style=" mask: url('https://images.cdn-files-a.com/ready_uploads/svg/calendar.svg?v=2'); -webkit-mask: url('https://images.cdn-files-a.com/ready_uploads/svg/calendar.svg?v=2');" data-ie11-classes="" alt="calendar">&nbsp;</i></span></div></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="select"><div class="form-group"><label for="select-1690946666670">Gender</label><span>*</span><select  name="select-1690946666670" class="form-control"><option class="c-f-field-title" disabled selected>Gender</option><option value="">Male</option><option value="">Female</option><option value="">Trans-Gender</option></select></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="select"><div class="form-group"><label for="select-1690946790990">Marital Status</label><span>*</span><select  name="select-1690946790990" class="form-control"><option class="c-f-field-title" disabled selected>Marital Status</option><option value="">Married</option><option value="">Unmarried</option></select></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="text"><div class="form-group"><label for="text-1690718339164">Blood Group</label><input type="text"  name="text-1690718339164" placeholder="Blood Group" class="form-control"></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="text"><div class="form-group"><label for="text-1690718353540">Email Address</label><input type="text"  name="text-1690718353540" placeholder="Email Address" class="form-control"></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="text"><div class="form-group"><label for="text-1690718398612">Phone Number (Whatsapp Number)</label><span>*</span><input type="text"  name="text-1690718398612" placeholder="Phone Number (Whatsapp Number)" class="form-control" required data-msg-required="This field is required."></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="text"><div class="form-group"><label for="text-1690946582402">Associated with (Village Kyidug/Samaaj)</label><input type="text"  name="text-1690946582402" placeholder="Associated with (Village Kyidug/Samaaj)" class="form-control"></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="textarea"><div class="form-group"><label for="textarea-1690718472170">Permanent Address: Landmark, Ward, District, PinCode</label><span>*</span><textarea  name="textarea-1690718472170" placeholder="Permanent Address: Landmark, Ward, District, PinCode" class="form-control" rows="6" required data-msg-required="This field is required."></textarea></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="textarea"><div class="form-group"><label for="textarea-1718429439241">GPU Name &amp; Constituency</label><span>*</span><textarea  name="textarea-1718429439241" placeholder="GPU Name &amp; Constituency" class="form-control" rows="6" required data-msg-required="This field is required."></textarea></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="textarea"><div class="form-group"><label for="textarea-1690718523444">Correspondent Address</label><textarea  name="textarea-1690718523444" placeholder="Correspondent Address" class="form-control" rows="5"></textarea></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="file"><div class="form-group"><label for="file-1690718782150">Recent Pass Photo</label><span>*</span><input type="file"  name="file-1690718782150" placeholder="Recent Pass Photo" class="form-control" required data-msg-required="This field is required."></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="file"><div class="form-group"><label for="file-1706860098787">Self Signature</label><span>*</span><input type="file"  name="file-1706860098787" placeholder="Self Signature" class="form-control" required data-msg-required="This field is required."></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="file"><div class="form-group"><label for="file-1690718784845">Address Proof (Voter ID/Aadhar Card)</label><span>*</span><input type="file"  name="file-1690718784845" placeholder="Address Proof (Voter ID/Aadhar Card)" class="form-control" required data-msg-required="This field is required."></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="file"><div class="form-group"><label for="file-1690718779114">SSC/COI/RC (Self/Father)</label><span>*</span><input type="file"  name="file-1690718779114" placeholder="SSC/COI/RC (Self/Father)" class="form-control" required data-msg-required="This field is required."></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="checkbox-group"><div class="form-group"><label for="checkbox-group-1690724867190">Payment Option</label><div class=""><label for="checkbox-group-1690724867190-0" class="checkbox-label"><input type="checkbox" id="checkbox-group-1690724867190-0" value="" name="checkbox-group-1690724867190[]" class="" required data-msg-required="This field is required."><span class="checkbox-custom"></span><span class="input-title">G-PAY @ 87689 75784</span></label><br><label for="checkbox-group-1690724867190-1" class="checkbox-label"><input type="checkbox" id="checkbox-group-1690724867190-1" value="" name="checkbox-group-1690724867190[]" class="" required data-msg-required="This field is required."><span class="checkbox-custom"></span><span class="input-title">Denzong Sherpa Association, SBI Gangtok, A/C 37256993060, IFS Code SBIN0000232</span></label><br></div></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="file"><div class="form-group"><label for="file-1690724800345">Fee payment receipt</label><span>*</span><input type="file"  name="file-1690724800345" placeholder="Fee payment receipt" class="form-control" required data-msg-required="This field is required."></div></div></div><div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="checkbox"><div class="form-group"><label for="checkbox-1690718918056" class="checkbox-label"><input type="checkbox" id="checkbox-1690718918056" name="checkbox-1690718918056" class="" required data-msg-required="This field is required."><span class="checkbox-custom"></span><span class="input-title">Declaration: I accept the constitution of Denzong Sherpa Association and I declare that the information given by me in this form and enclosures are true. I also declare that I am a Sikkimese by origin and citizen of India. I also declare that I have never been convicted for any criminal offences by any court.</span></label></div></div></div>

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