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home / membership form
Membership Form for Privilege Card
  Name
  Date of Birth / /
  Sex: Male Female
  Nationality
  Marital Status Single Married
  Occupation Business Service Self Employed Others
  Details of your occupation
  Total member in family   Adult   Children   infant
  Address:  

 

A) Residence
Tole: Street: Ward no.:
Municipality: District:
Phone: Mobile:
Email:  
   
   
   
         
B) Office
Tole: Street: Ward no.:
Municipality: District:
Phone: Mobile:
Email:  
   
   
   
  Date
   
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The Organic Village Pvt. Ltd, Bakhundol, Pulchowk, Lalitpur, Nepal.
Tel/fax: 977-1-5536403
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