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Registration Form

If any problem to use this site Please Contact Vimal Gulgulia :- +91-9460306844 A/c Name :- Akhil Bhartiya Terapanth Yuvak Parishad Bank Name :- Punjab national Bank, Branch: Ladnun A/c No.:- 10272010002800 IFSC Code:- PUNB0102710 A/c Name :- Akhil Bhartiya Terapanth Yuvak Parishad Bank Name :- State Bank of India, Branch:Ladnun A/c No.:- 30313076278 IFSC Code:- SBIN0007093 Subscription Charges for Yuva Dristi for Two Years By Courier Rs.1500/- and for Five Years By Courier Rs.3500/-
Registration Type (Member Type) :	TT YD Both
Membership Type* :
Member Name* :
Address 1* :
Address 2 :
Address 3 :
Pincode :
Residence State* :
Residence City* :
Native Place :
Phone :
Mobile* :
Mobile2 :
E-mail :
Registration Date* :
Cash / Cheque no.:
Cheque date :
Bank Recipt :
Parishad State Name* :
Parishad Name* :