Membership Joining Form

JCI Raipur Capital · Zone 27 · Year 2027

Personal details

Please type in English letters only.

Full name *

Mobile no. *

Age *

Address *

Aadhaar no. *

Introducer (JCI member) *

Business details

Business / profession *

Business name (optional)

Nature of business (optional)

Business address (optional)

Family details

Marital status *

Married Unmarried

Kids *

Yes No

Total family members *

Other details

Are you a member of any other organization? *

Yes No

Hobbies *

Pick one or more hobbies. Tap a selected hobby to remove it.

Photo and Aadhaar

Your photo * Choose photoPassport-size, front facing. JPG or PNG, up to 10 MB.

Aadhaar card * Choose Aadhaar imageClear photo of the front side. JPG or PNG, up to 10 MB.

Membership fee

Amount paid (Rs.) *

Mode of payment *

Cash Bank

Declaration and signature

I have read and understood the aims and rules of JCI and agree to abide by them. I confirm that the details given above are true. I understand that my membership is subject to approval by the Board of JCI Raipur Capital.

Sign inside the box *

Use your finger or mouse

Personal details

Business details

Family details

Other details

Photo and Aadhaar

Membership fee

Declaration and signature

Application received