Club Membership Registration Form

CLUB MEMBERSHIP FORM

Complete the form below to sign up for our membership. You will be notified when your membship form get approved.
Name*

First NameMiddle NameLast Name
Gender*

MaleFemaleN/A
E-mail
Phone Number:*

Area CodePhone Number
Address*

Full Address ( Tole, ward and Village)

Street Address Line 2

Rular Municipality/MunicipalityDistrict

Zip CodeCountry
Birth Date:*

MonthDayYear
Where did you hear about us?*

FriendsSocial MediaBlog PostNews Article
Membership Rules
1. Membership is available to anyone 18 years of age or older.

2. You promise NOT to use to conduct any fraudulent or business activity or have more than one Member Account at any time.
Privacy Policy
Please reach out and read our Privacy Policy in order to understand how your information is used and shared, and check below if you accept the policy.
I have read, understood, and accepted the PRIVACY POLICY for membership.
Once you submit your application, we will contact you shortly to complete your membership application. Thank you!

For any kind of queries just call us:

Nitesh Kumar Shah (Chairperson)-9819349007

Mr. Abhishek Shah (Treasurer)-9805394319

Follow us on Facebook : Laxminiya Yuwa Club
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CLUB MEMBERSHIP FORM