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Member
Registration
Fields marked
*
are Mandatory
*
Name :
*
Father Name / Husband Name :
*
Date Of Birh :
(Click the calendar button on left to select date)
*
Mobile /.LandLine No:
*
Address :
*
Ward / Village :
*
Constituency :
Select
1. Mannadipet
2. Thirubuvanai (SC)
3. Ossudu (SC)
4. Mangalam
5. Villianur
6. Ozhukarai
7. Kadirkamam
8. Indira Nagar
9. Thattanchavady
10. Kamaraj Nagar
11. Lawspet
12. Kalapet
13. Muthialpet
14. Raj Bhavan
15. Ouppalam
16. Orleampeth
17. Nellithope
18. Mudaliarpet
19. Ariankuppam
20. Manavely
21. Embalam (SC)
22. Nettapakkam (SC)
23. Bahour
24. Nedungadu (SC)
25. Thirunallar
26. Karaikal North
27. Karaikal South
28. Neravy T.R. Pattinam
29. Mahe
30. Yanam
*
Gender:
Male
Female
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Blood Group:
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O-
O+
A-
A+
B-
B+
AB-
AB+
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Caste:
SC
MBC
BC
Minority
Other
*
Qualification:
*
Occupation:
*
Temporary / Office Address:
*
Voter ID:
*
Ward No: