Member Registration

Membership Application Form

Important Information

Please fill out all required fields marked with an asterisk (*). Make sure to review the membership criteria and rules before submitting your application.

Personal Information

Full Name

Please enter your full name.

Father's Name

Please enter your father's name.

Date of Birth

Please enter a valid date of birth.

Mobile Number

+91

Please enter a valid 10-digit mobile number.

Email Address

Please enter a valid email address.

Education Information

MP Batch Year

HS Batch Year

Present Address

Street Address

Please enter your street address.

City/Village

Please enter your city or village.

District

Please enter your district.

State

Please select your state.

Country

Please select your country.

PIN Code

Please enter a valid 6-digit PIN code.

Permanent Address

Same as Present Address

Street Address

Please enter your street address.

City/Village

Please enter your city or village.

District

Please enter your district.

State

Please select your state.

Country

Please select your country.

PIN Code

Please enter a valid 6-digit PIN code.

Membership Type

Select Membership Type

Regular Member (Annual) - ₹500

Lifetime Member - ₹5,000

Please select a membership type.

Payment Method

Please select a payment method.

Payment details will be provided after form submission.

Security Verification

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I have read and agree to the terms and conditions of JALZISCAA membership.

You must agree to the terms and conditions to proceed.