Lead India Membership Form

Name of the Member Father’s Name Date of Birth Highest Educational Qualification Occupation Current Employer Adhaar Number PAN Mobile Number Email ID Residence Address District City State Andhra PradeshArunachal PradeshAssamBiharChhattisgarhGoaGujaratHaryanaHimachal PradeshJharkhandKarnatakaKeralaMadhya PradeshMaharashtraManipurMeghalayaMizoramNagalandOdishaPunjabRajasthanSikkimTamil NaduTelanganaTripuraUttar PradeshUttarakhandWest BengalAndaman and Nicobar IslandsChandigarhDadra and Nagar Haveli and Daman and DiuDelhiJammu and KashmirLadakhLakshadweepPuducherryOther Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamas TheBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBritish Virgin IslandsBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChannel IslandsChileChinaColombiaComorosCongo Dem RepCongo RepCosta RicaCote dIvoireCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgypt Arab RepEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambia TheGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea BissauGuyanaHaitiHondurasHong Kong SAR ChinaHungaryIcelandIndiaIndonesiaIran Islamic RepIraqIrelandIsle of ManIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea Dem Peoples RepKorea RepKosovoKuwaitKyrgyz RepublicLao PDRLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao SAR ChinaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesia Fed StsMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten Dutch partSlovak RepublicSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSt Kitts and NevisSt LuciaSt Martin French partSt Vincent and the GrenadinesSudanSurinameSwedenSwitzerlandSyrian Arab RepublicTajikistanTanzaniaThailandTimor LesteTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuela RBVietnamVirgin Islands USWest Bank and GazaYemen RepZambiaZimbabwe

Ready to join as “Lead India Governing Body” YesNo List of Social Activities Participated List of Achievements or Awards achieved Select Volunteer Work from below a. Work as Trainer to impart training to Youth of Indiab. Maintain network of Schools, Colleges, Villagesc. Social Media Posting and Registration of new Volunteersd. Organize Lead India Training Programs online and offlinee. Sourcing Sponsors and CSR funds for Lead India Trainings Membership Donation a. Annual Member – Rs.1000b. Life Member – Rs.10,000c. Patron Member – Rs.100,000