ଆମ୍ ଆଦ୍ମୀ ପାର୍ଟି, ଓଡିଶା
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AAM AADMI PARTY, Odisha
ସଦସ୍ୟତା ପଞ୍ଜିକରଣ ଫର୍ମ
Full Name (ନାମ)* :
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ଆପଣଙ୍କ ପୁରା ନାମ
Mobile Number(ମୋବାଇଲ ନମ୍ବର)* :
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ମୋବାଇଲ୍ ନମ୍ବର
Age(ବୟସ)* :
Below 12 yrs
12-17 yrs
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61-65 yrs
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71-80 yrs
81-90 yrs
91+ yrs
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ଆପଣଙ୍କ ପୁରା ନାମ
Gender(ଲିଙ୍ଗ)* :
Male(ପୁ)
Female(ମ)
Other(ଅନ୍ୟ)
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Gender(ଲିଙ୍ଗ)
Father's Name (ପିତାଙ୍କ ନାମ)* :
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Enter Father's Name - ଆପଣଙ୍କ ପିତାଙ୍କ ନାମ
Mother's Name (ମାତାଙ୍କ ନାମ)* :
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Enter Mother's Name - ଆପଣଙ୍କ ମାତାଙ୍କ ନାମ
District(ଜିଲ୍ଲା)* :
Angul
Balasore
Bargarh
Bhadrak
Boudh
Cuttack
Deogarh
Dhenkanal
Gajapati
Ganjam
Jagatsinghapur
Jajpur
Jharsuguda
Kalahandi
Kandhamal
Kendrapara
Kendujhar
Khordha
Koraput
Malkangiri
Mayurbhanj
Nabarangpur
Nayagarh
Nuapada
Puri
Rayagada
Sambalpur
Sonepur
Sundargarh
Balangir
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Assembly (ବିଧାନସଭା) :
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Anandpur
Angul
Aska
Athgarh
Athmallik
Attabira
Aul
Badasahi
Balasore
Baliguda
Balikuda-Erasama
Bangriposi
Banki
Barabati-Cuttack
Baramba
Barchana
Bargarh
Bari
Baripada
Basta
Basudevpur
Begunia
Berhampur
Bhadrak
Bhandaripokhari
Bhanjanagar
Bhatli
Bhawanipatna
Bhograi
Bhubaneswar Central
Bhubaneswar North
Bijepur
Binjharpur
Biramitrapur
Birmaharajpur
Bissam Cuttack
Bolangir
Bonai
Boudh
Brahmagiri
Brajarajnagar
Champua
Chandabali
Chhatrapur
Chhendipada
Chikiti
Chilika
Chitrakonda
Choudwar-Cuttack
Cuttack Sadar
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Ekamra Bhubaneswar
G. Udayagiri
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Mahanga
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Mohana
Morada
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Saraskana
Satyabadi
Simulia
Sonepur
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Surada
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Enter Assembly Name - ଏଠାରେ ବିଧାନସଭା ନାମ ପୂରଣ କରନ୍ତୁ
Ward(ୱାର୍ଡ)/ Panchayat(ପଞ୍ଚାୟତ) :
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Ward(ୱାର୍ଡ)/ Panchayat(ପଞ୍ଚାୟତ)
Pincode* :
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Enter Valid Pincode
Address (ଠିକଣା) :
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Membership Type (ସଦସ୍ୟତା ପ୍ରକାର)* :
General Membership(ସାଧାରଣ ସଦସ୍ୟତା)
Organisation Building(ସଙ୍ଗଠନ ନିର୍ମାଣ)
Social Media(ସୋସିଆଲ ମିଡିଆ ସହଯୋଗ)
Financial Support/ଆର୍ଥିକ ସହାୟତା
Others/ଅନ୍ୟ
Voter ID Number (ଭୋଟର କାର୍ଡ ନମ୍ବର) :
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Enter Voter ID Number (ଭୋଟର କାର୍ଡ ନମ୍ବର)
Aadhar Card Number (ଆଧାର କାର୍ଡ ନମ୍ବର) :
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Enter Aadhar Card Number (ଆଧାର କାର୍ଡ ନମ୍ବର)
Remark(ଆପଣଙ୍କ ମନ୍ତବ୍ୟ) :
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