Particulars Regarding Children and Other Dependent Members (staying along with)
Permanent House Address(Address In Native Place):
Local Address (Residential) :
Local Address (Optional) :
Telephone Number:
Mobile Number:
Email:
I hereby declare I will abide by the constitution of the Kutch Kerala Samajam, Gandhidham. I also declare that I am not/a member of any other Samajam/Welfare Association in Kutch District.
or you can download the Membership Form
For more details you may please contact