1/1/14

1/1

Membership Form

Form Number : 9000719788 Date : 01 Jan 2014

State : HIMACHAL PRADESH District : KANGRA

Name : Mr.abhinav dogra

Father's Name : Chander Shekhar Dogra

Age (in Years) : 19

Address : 5, adrash colony balaji vihar kangra H.P. 176001

Mobile Number : 8894040029

Email ID : dograabhinav07.ad@gmail.com

Democracy is popular self rule, but the current practice of democracy negates this ideal and reduces thecitizens to mere subject. Aam Aadmi Party aims to restore power to the people, so as to realize thepromise of Swaraj enshrined in our constitution.

"I am a Citizen of India. I am above 18 years of age. I am not a member of any political party. I believe inthe objectives and thinking of the party and I am willing to fully participate in achieving the objectives ofthe party."

" म� भारत का नाग�रक हू ँ। म� 18 वष� क� आय ुपरू� कर चकुा हू ँ। म� �कसी भी पजंीकृत राजनी�तक दल का सद�य नह�ंहू ँ। मझु ेपाट� के उ��ेय� और �वचार� म� परू� आ�था ह ैऔर म� पाट� के ल�य� क� प�ूत� म� अपना पणू� योगदान दने ेकोइ�छुक हू।ँ "

(आवदेक के ह�ता�र / Applicant’s Signature)

नोट/Note :

इस ��टंआउट को � . 10/- के पो�टल आड�र के साथ अपन ेशहर के पाट� द�तर म� जमा कर� या पाट� के क���यकाया�लय को इस पत ेपर डाक �वारा भजे� - Ground floor, A-119, Kaushambi, Ghaziabad, UP, 201010. Submit this printout along with a postal order of Rs.10/- at the party office of your city OR send theprintout and postal order to our national office at - Ground floor, A-119, Kaushambi, Ghaziabad, UP,201010.

हमन े�कसी भी �यि�त को पाट� क� ओर स ेपसै ेइक�ा करन ेको अ�धकृत नह� ं�कया ह.ै अगर आप अपना फॉम��कसी �यि�त के मा�यम स ेहमार ेद�तर तक भजे रह ेह� तो इस बात का �यान रख� �क वह �यि�त आपका �व�व�तहो | We have not authorized any individual to collect money on behalf of the Party. In case you send the formthrough someone else, please do it through a trusted person only.

www.aamaadmiparty.org | 09718500606 | contact@aamaadmiparty.org

www.facebook.com/AamAadmiParty | Twitter : @aamaadmipartyOffice of the Aam Aadmi Party,

Ground floor, A-119, Kaushambi, Ghaziabad, UP, 201010.