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Registration Form

Literacy Campaign/Hiv-Aids/Blood Donation/EYE-Donation/Street Childrens/Medical Assistance/Membership

1 Name of the Person *
2 Date of Birth
3 Address for Communication *
4 Phone No. *
5 Mobile No.
6 E Mail Address*
7 Blood Group *
8 Would you like to Donate

- Blood

- Eyes
Yes No
Yes No
9 Please confirm, whether you need
assistance for Job placement
(forward ur updated resume to
Yes No
10 Please specify the areas in which
you would like to contribute