HUMANIST PARTY MEMBERSHIP FORM

Notes:- Fields marked with an asterisk(*) are mandatory.

Membership Details

Full Name *

S/O, D/O, W/O *

Complete Postal Address *

State *

District/City *

Pincode *

Phone Number *
country code. landline/mobile

Email-id *

Occupation *

Date of Birth *

Date

Month

Year

Upload Your Photo *

Introduced By *
a). Name of the member:
b). Internet visitor:

Membership Options

Membership Type

Additional

Total Amount Payable

Declaration

I declare that the particulars mentioned above are true and correct to the best of my knowledge and that I have not made any misrepresentation or concealment whatsoever. I hereby indemnify the HPI against any misdemeanour by me directly or indirectly. Being a Humanist Party member, I pledge to refrain from committing any form of violence, discrimination, exploitation or corruption directly or indirectly. I also undertake to abide by the rules and regulations of the organisation, as amended from time to time.