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Citizen Member Registration
First Name:
*
Middle Name:
Last Name:
*
Gender:
*
--Select Gender--
Female
Male
Transgender
Mobile No:
*
Email Id:
District:
*
--Select District--
24 PARAGANAS NORTH
24 PARAGANAS SOUTH
Alipurduar
BANKURA
BIRBHUM
COOCHBEHAR
DARJEELING
DINAJPUR DAKSHIN
DINAJPUR UTTAR
HOOGHLY
HOWRAH
JALPAIGURI
Jhargram
KALIMPONG
MALDAH
MEDINIPUR EAST
MEDINIPUR WEST
MURSHIDABAD
NADIA
PASCHIM BARDHAMAN
PURBA BARDHAMAN
PURULIA
Block:
*
--Select Block--
GP:
*
--Select GP--
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