JEEV AASHRAYA MEMBERSHIP REGISTRATION
Personal Information
Name
*
Father's Name
*
D.O.B
*
Gender
*
--- Select Gender ---
Male
Female
Marital Status
*
--- Select Marital Status ---
Married
Unmarried
Wedding Anniversary Date
Aadhar No
*
PAN Number
*
Profile Picture
Contact Information
Mobile No
*
Whatsapp No
*
Email
*
City
*
Address
*
Area Locality
*
Pincode
*
State
*
Country
*
Social Media Info
Please Provide Your Facebook Profile Link (Optional)
Please Provide Your Twitter Page Link (Optional)
Please Provide Your Instagram Page Link (Optional)
Please Provide Your Youtube Channel Link (Optional)
Education / Employment Information
Highest Education
Employment Information
Interests
1. Which Category You Belong To?
Vegetarian
Non Vegetarian
Vegan
2. Do You Love Animals?
--- Select Interests ---
Yes
No
3. Do You Have A Pet?
--- Select ---
Yes
No
4. What Is The Breed Of Your Pet?
5. Please Upload The Picture Of Your Pet.
6. Should Animals Be Given Proper Love, Care And Quality Like Humans?
Yes
No
May Be
7. Have You Ever Been A Part Of Animal Rescue Operations?
Yes
No
8. Have You Adopted Any Stray Animal?
Yes
No
9. Are You Associated With Any Animals Welfare Organization?
Yes
No
10. What Improvement Would You Like To See In Animal Welfare?
11. Would You Like To Join Our Jeev Aashraya Membership?
Yes
No
12. How Would You Like To Join Us?
Membership
Volunteer
Employee
13. Would You Like To Do Your Bit For Animal Welfare?
*
Definitely Yes
No
14. How Much Would You Like To Promise Monthly Support For Animal Welfare?
*
--- Select Support Amount In Rs ---
100
200
500
1000
2000
5000
More Than 5000
Promise Monthly Donation Amount
Extra Information (Optional)
Would you like to subscribe support amount (Autodebit)
Yes
No
Referred By
Reference Code
Submit
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