For Lifetime Member - Denzong Sherpa Association

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One Time Membership Fee - Rs. 5000

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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-1690717807906">Full Name</label><span>*</span><input type="text"  name="text-1690717807906" 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-1690717816182">Name of Father &amp; Mother</label><span>*</span><input type="text"  name="text-1690717816182" 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-1690719815178">Ru (Clan/Thar)</label><span>*</span><input type="text"  name="text-1690719815178" 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-1690719799571">Date of Birth</label><span>*</span><div class="input-group f-b-date-timePicker"><div data-related-id="datePicker-1690719799571" 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-1690719799571" name="datePicker-1690719799571" 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-1690947032803">Gender</label><span>*</span><select  name="select-1690947032803" 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-1690947030767">Marital Status</label><span>*</span><select  name="select-1690947030767" 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-1690719715863">Blood Group</label><input type="text"  name="text-1690719715863" 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-1690719700386">Email ID</label><input type="text"  name="text-1690719700386" placeholder="Email ID" 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-1690719660428">Phone Number (Whatsapp Number)</label><span>*</span><input type="text"  name="text-1690719660428" 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-1690947028299">Associated With (Village Kyidug / Samaaj)</label><input type="text"  name="text-1690947028299" 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-1690719622436">Permanent Address: Landmark, Ward, GPU, Constituency, District, PinCode</label><span>*</span><textarea  name="textarea-1690719622436" placeholder="Permanent Address: Landmark, Ward, GPU, Constituency, 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-1690719600165">Correspondent Address</label><textarea  name="textarea-1690719600165" 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-1690719534708">Recent Pass Photo</label><span>*</span><input type="file"  name="file-1690719534708" 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-1706860432505">Self Signature</label><span>*</span><input type="file"  name="file-1706860432505" 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-1690719532674">Address Proof (Voter ID/Aadhar Card)</label><span>*</span><input type="file"  name="file-1690719532674" 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-1690719530146">SSC/COI/RC (Self/Father)</label><span>*</span><input type="file"  name="file-1690719530146" 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-1690725045117">Payment Option</label><div class=""><label for="checkbox-group-1690725045117-0" class="checkbox-label"><input type="checkbox" id="checkbox-group-1690725045117-0" value="" name="checkbox-group-1690725045117[]" 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-1690725045117-1" class="checkbox-label"><input type="checkbox" id="checkbox-group-1690725045117-1" value="" name="checkbox-group-1690725045117[]" 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-1690725049127">Fee payment receipt</label><span>*</span><input type="file"  name="file-1690725049127" 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-1690719504833" class="checkbox-label"><input type="checkbox" id="checkbox-1690719504833" name="checkbox-1690719504833" 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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