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Membership Application Form

Kindly note that : Fields marked with Asterisk (*) are mandatory
Personal Details
Name *
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
 I want to join Friends of BJP Network (Minimum Amount Rs. 100/-) INR
 Check this box, if you have been a BJP Member in the past
Subscription
Kamal Sandesh (Hindi/English 1 Year Rs. 100/- or Hindi/English 3 Year Rs. 250/-) INR
Please enroll me for Aajiwan Sahayog Nidhi ( Rs. 1,000/-, Rs. 5,000 & Rs. 10,000/-)  INR
Contribution
 Voluntary Contribution (Minimum Amount Rs. 100/-) 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 the Bharatiya Janata Party.
I am committed to Nationalim 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 Discripline of the Party.

Date: ................................ Signature ..................................


http://www.bjp.org/membership

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