MEMBERSHIP FORM

THANE ART GUILD TRUST Regn. No. – E/8287/Thane

---

All fields are mandatory

Full Name (संपूर्ण नाव)

Email address (ई-मेल आयडी)

Country Code Choose 91 --- India 1 --- USA 44 --- United Kingdom 94 --- Sri Lanka 61 --- Australia 93 --- Afghanistan 880 --- Bangladesh 975 --- Bhutan 55 --- Brazil 33 --- France 49 --- Germany 30 --- Greece 39 --- Italy 64 --- New Zealand 65 --- Singapore 27 --- South Africa 46 --- Sweden 41 --- Switzerland 971 --- United Arab Emirates 263 --- Zimbabwe

(Cell/भ्रमणध्वनी)

Enter Password (पासवर्ड टाका)

Confirm Password (पासवर्ड पुष्टी)

 

Date of Birth (जन्म तारीख)

Age

Profession (व्यवसाय) Choose Actor Film/Drama Director Singer Writer Poet Dancer/ Choreographer Calligraphy Painting/ Sketching Voicing/Dubbing Rangoli Instrument Player Music Composer Sculptor Editor Other

 

Home Address (घरचा पत्ता)