Members

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The is the application form to become a member of Indigenous Peoples of Mung Dun Chun Kham, Assam, North East India (IPMDCKANEI).

A membership fee is charged: Rs.300/- per member.

For any issues, please contact Anup Arandhara, Secretary General at 9101841554 or email: anup@assam.org.

** Data submitted here will be used to prepare online genealogical database of your family.

Title

First

Middle

Last

Father's Name

Please enter date of birth. If the person if dead, please enter date of death (for genealogy purpose)

Mother's Name

Please enter date of birth. If the person if dead, please enter date of death (for genealogy purpose)

Age/Date of Birth

Contact No.

Your Address

Highest Education Qualification & Profession

Name in Indigenous Language

Address in Indigenous Language

Religion

Ethnicity & Caste

Genealogy with Historical reference