Registration New Member : The All india Health Workers Legal Services & Welfare Association

Membership Registration Form

Referral Code(Member Id)

Full Name *

Father's/Husband's Name *

Date of Birth *

Permanent Contact No. *

Email ID *

Permanent Home Contact No. *

Academic Qualification *

Professional Qualification *

Registration No. *

Religion *

Blood Group *

Nationality *

Voter Card No./Aadhar No. *

State *

District *

Address Line 1 *

Address Line 2 *

Police Station *

Pincode *

Upload Photo *

Membership Fee - ₹ 1

I have read and agree / agreed with the terms and conditions

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