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Membership Application Form

Personal Details

Name*



Kindly note that: Fields marked with Asterisk (*) are mandatory

Gender Male Female Date of Birth*
Your Basic Profile



Contact Details

Home Address * State *

Lok Sabha Seat

Assembly Seat

Pin Code Telephone

Mobile 1* Mobile 2

Email Address 1* Email Address 2

Membership

I Want to apply for BJP Membership (RS. 5/-) INR
Check this box, if you have been a BJP Member in the past
I want to associated with



Subscription

Kamal Sandesh (Hindi/English 1 Year Rs. 100/- or Hindi/English 3 Year Rs. 250/-) INR

Contribution
Party Fund INR

Please enrol me for Aajiwan Sahayog Nidhi (Rs. 1000/-, Rs. 5000/-, Rs. 10000/- & Above) INR
Total Amount INR
Please Enter Demand Draft or Cheque Number in favour of Bharatiya Janata Party.

Declaration
I do hereby declare that, the contribution are from my personal fund and voluntary by nature.
PLEDGE
I believe in integral Humanism which is the basic philosophy of Bharatiya Janata Party.
I am committed to Nationalism and National Integration, Democracy, Gandhian approach to socio-economic issues leading to
the establishment of an egalitarian society free from exploitation, Positive Secularism, (Sarva Dharma Sama Bhava) and Value
based politics.
I subscribe to the concept of the Secular State and Nation not based on religion.
I firmly believe that this task can be achieved by peaceful means alone.
I do not believe in discrimination based on caste, sex or religion.
I do not observe or recognize untouchability in any shape or form.
I am not a member of any other political Party.
I undertake to abide by the Constitution, Rules and Discipline of the Party

Date: .. http://www.bjp.org/membership Signature:..

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