Membership Form: Individual Member Please enable JavaScript in your browser to complete this form.Full Name: *Date of Birth: *Gender: *MaleFemaleOtherNationality: *Address: *City / Town / Village: *State: *PIN Code: *Phone Number: *Email *Membership Duration: 1 Year3 Year5 YearLife MemberMembership Type: Individual MemberAreas of Interest: *Volunteering Availability: *YesNoHow did you hear about us?: Payment Information: <br />Membership Fee: INR *Payment Method: *Credit CardDebit CardUPIBank TransferDeclaration: I hereby declare that the information provided is true and correct. I agree to abide by the rules and regulations of the SAMVAW Foundation. *Date: *NameSubmit
