Gender  Male     Female   
   Date of Birth Year: Month: Day:
   Vidhan Sabha Constituency
   Pin Code
   Voter ID Number
   Personal Mobile Number*
   Email ID
Check if you are a Student
Are you willing to work from* Home Outside Both
Do you have access to computer and Internet Yes No
Areas where you can volunteer *
Fund Raising On the ground work
Office administration Data entry
System administrator Tele campaigning
Graphic designing Coordinators/managers
Volunteer management Translators
Researchers Trainers
Technical support / Information Tech. Logistic
Creative (poets,musicians,artists,street theater) Social Media Moderator
Accounting/Finance Publicity/Advertisement
Doctor/ Healthcare Legal
Public Speaking Media/ Journalism/ Communication
Photographer/Videographer Video Editor/ Film Maker
Have you volunteered in Past Yes No
   Emergency Contact Number*
    Upload your photo
(To ensure your card with photo)
I am citizen of India. I am above 18 years. I am not a member of any other political party registered with the Election Commission of India. I am not a member with any organization whose views, policies or actions are in conflict with the objective of the party. I have not been convicted of any offence involving moral turpitude. I have full faith of party's objective and vision. I wish to support the party in achieving its goals. The particulars and statements made above are correct to the best of my knowledge and nothing has been concealed or withheld.