Odisha International Center

1. Must be above 18 years of age Male/Female with sound mind irrespective of caste/creed and religion.

2. Having good personality and social service back ground.

3. A disciplined, polite and undisputed person.

4. Responsibility for induction to a new member and also to withhold the membership vests with a selection committee.

Registration Date : Name of the Member :

Age : Date of Birth:

Father’s Name: Spouse Name :

AADHAR No: Occupation /Organization:

Membership Receipt No : Present address:

Permanent address : Mobile/ Whatsapp No:

Alternate Mob no in case of emergency: : Blood Group :

Email Id: Hobbies/any other activities :

Whether associated with any other organization (s): Since when :

I do hereby declare and confirm that the above information given by me is true to the best of my knowledge and belief. click yes if you agree