Renewable of Membership - Denzong Sherpa Association

FOR GENERAL MEMBER

<div class="row"><div class="col-xs-12 c-f-field-type" data-field-type="text"><div class="form-group"><label for="text-1690723745855">Full Name</label><span>*</span><input type="text"  name="text-1690723745855" 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-1690724407154">Name of Father &amp; Mother</label><span>*</span><input type="text"  name="text-1690724407154" 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-1690724421204">Permanent Address</label><span>*</span><input type="text"  name="text-1690724421204" placeholder="Permanent Address" 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-1690724439973">Membership Number</label><span>*</span><input type="text"  name="text-1690724439973" placeholder="Membership 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="checkbox-group"><div class="form-group"><label for="checkbox-group-1690724040491">Payment Option (Renewable Fee Rs. 100)</label><div class=""><label for="checkbox-group-1690724040491-0" class="checkbox-label"><input type="checkbox" id="checkbox-group-1690724040491-0" value="" name="checkbox-group-1690724040491[]" 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-1690724040491-1" class="checkbox-label"><input type="checkbox" id="checkbox-group-1690724040491-1" value="" name="checkbox-group-1690724040491[]" 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-1690723753689">Fee payment receipt</label><span>*</span><input type="file"  name="file-1690723753689" placeholder="Fee payment receipt" class="form-control" required data-msg-required="This field is required."></div></div></div>

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