Monthly Patronage Scheme

I have paid the monthly patronage subscription of Rs. 1000/= , and a clear photo of the payment slip is ready to be attached.

Prefix

First Name *

Last Name *

Phone *

Email *

I am a

Username *

Password *

Street Address

City

State/Province

ZIP / Postal Code

Country

Date of Birth *

A recently taken photo of the applicant *

No file chosen

A Clear Photo of your ID, or Driver's License *

Upload both sides of National ID, or front only of Driver's License

Photo of the payment slip *

No file chosen